Download article PDF - Hepatitis E epidemic looms in Darfur

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Hepatitis E epidemic                                                                     are all there and very well demon-
                                                                                         strated—overcrowding, no water,
                                                                                                                                in their insistence that more aid is
                                                                                                                                required to avert mass deaths.

looms in Darfur                                                                          no latrines. We are trying to create
                                                                                         some sort of response in case
                                                                                                                                Rowan Gillies said, “All their
                                                                                                                                coping mechanisms are gone.
                                                                                         there is an epidemic, but I think      These people escaped with just
Karen Hebert London                                                                      we will encounter a large number       pots and pans or with just the
                                                                                         of people who will die.”               clothes on their back. They have
At the time of going to press the                  able and fear that maternal deaths        In addition, an outbreak of        very little ability to cope with any
World      Health    Organization                  may skyrocket.                        shigellosis has been reported in       further insult.”
confirms that 625 cases of infec-                       This message comes shortly       the Abu Shoak camp, which has              The conflict began in 2003
tion with hepatitis E virus and 22                 after Rowan Gillies, president of     approximately 40 000 people.           when rebel groups said that the
deaths have been documented in                     Médecins       Sans     Frontières,   WHO has been notified of 1340          government was oppressing black
western Sudan. The UN Popula-                      warned that Darfur was “An            cases of bloody diarrhoea with 11      Africans in favour of Arabs. The
tion Fund and WHO both                             epidemic waiting to happen.”          resulting deaths in the Darfur         government admitted to mobil-
warned that the virus—which is                          Dr Gillies explained that the    region.                                ising antirebel forces but deny any
usually transmitted through water                  number of latrines available in the       Food deliveries are inadequate     links to the Janjaweed militia. The
contaminated with human waste—                     whole of western south Darfur is      and uneven across Darfur. A            Janjaweed have attacked, raped,
could spread quickly in Darfur,                    minimal at best. In addition, water   recent national survey of four         and killed many black Africans in
where hundreds of thousands of                     is in very short supply, with         refugee camps found severe             what is being described as “ethnic
refugees live in overcrowded                       people getting only 8-10 of the 20    malnutrition of between 4.1% and       cleansing.”
camps with poor sanitation.                        litres needed per day. He             5.5%. This is expected to increase         Up to 1 million people have
    Three quarters of the fatalities               expressed concern over the            with the rainy season, which has       had to flee their homes, and up to
in one camp were pregnant                          potential for an epidemic: “To be     rendered many of the camps             50 000 people have been killed in
women. warns that pregnant                         honest, if you want to create the     virtually inaccessible.                what the UN has termed “The
women are particularly vulner-                     environment for an epidemic it’s          Aid agencies are unanimous         world’s worst humanitarian crisis.”

Poor countries need to                                                                   tional Development, the authors
                                                                                         looked at Ghana, a net exporter
                                                                                                                                recruiting internationally to fill
                                                                                                                                rural posts.
tackle the brain drain                                                                   of health workers; South Africa,
                                                                                         an importer and exporter; and
                                                                                                                                    The report says that many
                                                                                                                                African doctors also migrate
Roger Dobson Abergavenny                                                                 England, a net importer.               within the continent, mostly to
                                                                                             The authors, Peter Bundred         southern African states where
With the United Kingdom                                “Source countries must work       from the department of primary         salaries are often higher: for
needing 10 000 more doctors,                       on improving staff attraction         care, Liverpool University, Tim        instance, $1242 a month in
and with more than 7000 nurses                     and retention. Recipient coun-        Martineau from the Liverpool           South Africa, compared with
from the Philippines alone                         tries should also try to get their    School of Tropical Medicine,           $50 in Sierra Leone.
currently registered in the                        own houses in order so they are       and Karola Decker from the                 It suggests that some of the
United Kingdom, compared                           not a permanent drain on health       University of Hamburg, say that        demand in developed countries is
with just 52 in 1999, a new                        professionals from the South,”        the effects on source countries of     due to the pyramidal structure of
report says that the countries                     says a study in Health Policy         losing health workers can be           the workforce: a large number of
providing the workers, as well as                  (2004;70:1-10).                       serious.                               junior and intermediate level
those that hire them, need to                          In research funded by the             “The Centre for Spinal             doctors supporting a small
look for solutions.                                UK’s Department for Interna-          Injuries in Boxburg, near Johan-       number of consultants. “The
                                                                                         nesburg, South Africa was the          structure works if foreign medical
                     Average monthly salary (in US dollars) for junior doctors in        referral centre for the whole          graduates contribute to the mid-
                     African countries                                                   region. On the same day in 2000        and lower level posts in hospitals.
 Salary ($)

                                                                                         the two anaesthetists were             In the UK foreign medical gradu-
                                                                                         recruited by a Canadian institu-       ates trained outside the European
                                                                                         tion opening a new Spinal              Economic Area make up 65% of
              1200                                                                       Injuries Unit. A consequence of        the staff grades compared with
                                                                                         the loss of these two key staff was    17% of consultants,” the report
                                                                                         the temporary closure of the           says.
               900                                                                       centre,” says the report.                  It says that, to allow proper
                                                                                             The authors report that India      monitoring, accurate data on the
                                                                                         has lost up to $5bn (£2.7bn;           numbers of migrating health
                                                                                         €4.1bn) in investment in training      professionals are needed.
                                                                                         of doctors since 1951 and that             “The negative impact on
                                                                                         Ghana has lost around $60m.            health services… of mass recruit-
                                                                                             The authors say a “carousel”       ment of health professionals by
               300                                                                       movement of doctors exists. The        industrialised countries seems to
                                                                                         Canadian provinces of Alberta          be beyond dispute. Since the
                                                                                         and Saskatchewan, for example,         pressure from richer nations on
                 0                                                                       have been recruiting actively in       the international health labour
                       Ghana     Lesotho    Namibia     Sierra     South     Zambia      South Africa for GPs to work in        market is clearly set to increase,
                                                        Leone      Africa
                                                                                         remote rural areas. At the same        the situation is likely to get
Source: Health Policy
                                                                                         time South Africa has been             worse.”

312                                                                                                                         STUDENTBMJ | VOLUME 12 | SEPTEMBER 2004