The Big Picture

The state of health care  . . .

Stories in the Post and the Times over the weekend reported Government’s concern over its shortage of nurses, other health workers and essential services. These stories suggest a wealth of quick follows that could bring both problems and solutions to light — and give a glimpse of the overall state of health care here.

What is a day in a life of a nurse here like now? How have pay and benefits changed in recent years and what have been the effects of those changes?  What happens when a patient needs an ambulance at Livingstone General Hospital? And how does all of this affect people with needs for ongoing care — for high blood pressure, diabetes, heart disease, cancer —  as well as for HIV and tuberculosis? A day following one patient could offer valuable information on gaps in a system that policy makers and donors are seeking to strengthen.

That information is needed — and reporters can be the ones to provide it — if the well-publicized roll-outs of effort and resources to address malaria and HIV are to do their greatest good, and in fact, not detract from overall health services.

In the last couple of weeks reports and opinion pieces have suggested areas that would be interesting to follow here:

This piece by Mark Green, Managing Director of Malaria No More’s Malaria Policy Center in Washington, DC., argues that coordinating efforts to prevent and treat malaria with efforts to address neglected tropical diseases would help strengthen health services in general — particularly in remote areas where the gaps are the greatest now. The Tropical Disease Research Center in Ndola, which has studies neglected tropical diseases could be a good place to start.

This piece, on http://www.globalhealthmagazine.com looks at how, with urbanization, Africa “has acquired the so-called diseases of the wealthy, but without the wealth.” Examining the toll of mental illness, cardiovascular disease, diabetes, cancer  here — one of the most urbanized countries in Southern Africa — would provide essential services to readers. What are people doing differently, and what health-harming behaviors are preventable and avoidable? And of course, how does the health care system need to adapt to the rising burden of unpublicized public health threats?

Are prevention strategies working?
Finally, this New York Times story brings good news, but the reminder that while “more than a million people were put on drugs in the past year — drugs they will need for the rest of their lives — 2.7 million people were newly infected with H.I.V. in 2007, the latest year for which there were estimates” demands a local look at prevention strategies, including in health care settings.

And, an addition to the Bad Words List
” . . . he said, in a speech read for him by . . .”
Okay, that’s a combination of words, but it is a phrase that confuses me. If someone “says” something, the words come out of that person’s mouth. That person is present, and can then answer a question that may be raised by those words. But too often reporters writing stories from the transcripts of speeches don’t ask those questions — or have the opportunity to ask them — because the author of the speech being reported isn’t actually there. It would be good to make that clearer from the start: “a government spokesperson said today that . . . ” followed by “he was reading a speech from . . .” Then, ask the questions raised by the speech. The answers could always provide a good follow-up story.

An Ailing Healthcare System Gets a Look

There has to be a better way . . .

Recently I was speaking to an exhausted young doctor here who talked about how available resources, including medical, administrative and support staff are falling far short of the needs of a growing number of patients with illnesses both related and not to HIV.

I mentioned the hope that had seemed to exist once that efforts to address HIV epidemics in poor countries would, in the long run, strengthen health systems.

“They haven’t, in fact, they have done the opposite,” the doctor answered.

A report from the U.S. National Bureau of Economic Research, detailed on Irin Plus News backs up that doctors perception with recent Demographic Health Surveys from 14 African countries including Zambia. The report finds that in regions where HIV prevalence is the highest, antenatal care, attended births, and childhood immunizations have all diminished from 1988 to the present. The report relies on intricate mathematics to examine the reasons for this trend — and while this can make journalists flinch, a look at the report for specific areas of impact in Zambia is worth it. In addition, if you are interested in pursuing the story you can start with the DHS itself,  the link to which also has been added to the sidebar.

A look at this deteriorating situation could provide a revealing and important story, that, in turn could prompt closer scrutiny on a policy level. As the NBER report points out, “Unfortunately, women and children in sub-Saharan Africa cannot wait for another round of DHS surveys to come on line. We must find alternative ways to investigate the roots of this erosion of service.”

Violating Human Rights Runs Counter to Public Health

An excellent (if sensationally headlined) feature in the the Sunday Post: “Secret Lives of Lesbians . . .” is a timely look at the marginalization of one segment of Zambia’s population, coming, as it does, in the week New Delhi ended its criminalization of gay sex. The ban — a holdover from its Colonial past — was found to be defeating HIV-prevention work, in addition to being, as a judge put it, a “violation of fundamental rights.”

As Zambia’s Mid-term HIV strategy report suggests this country examine its own criminalization of homosexuality, the Post story opens the door to looking a discriminatory law that UNAIDS has said runs counter to the interests of public health.

The International AIDS Conference in Capetown and NPF’s J2J Training: Stories, resources, issues . . .

For health-oriented journalists looking for stories, contacts, information and resources, there likely is no better opportunity, literally in the world than the annual J2J weeklong training offered by the Washington, DC-based National Press Foundation preceding the International AIDS Society conferences. About 50 journalists from 30 or more countries each year get to go, and have the oppportunity to learn from each other, as well as from the conference headliners and experts who come to address the group.

If you are not one of the fortunate attending this year’s training in Cape Town next week, you still can glean some of the benefit by following live blogging during the conference from NPF as well as summaries from the IAS conference Web site

You have until July 31st 2009 to participate in the Lorenzo Natali Prize… don’t wait!

The Lorenzo Natali Prize is a competition organised by the European Commission. It rewards the journalists that have been dealing with issues such as democracy, human rights and the developing world.

For the first time this year, the Lorenzo Natali Prize is open to radio and television journalists.

If you have not applied yet… you have a few days left to fill in your application form.

To apply, you simply have to check the website http://www.nataliprize2009.eu and submit online your application.

Each applicant can submit ONE journalistic work or ONE extract of journalistic work published or aired between January 1st, 2008 and June 15th, 2009.

The seventeen winners of the Lorenzo Natali Prize will be guests of honour of the European Commission during a stay in Sweden. Each winner will receive a trophy and a prize. Overall, 60,000 euros of prize will reward the best works.

For further information or to apply, feel free to visit the website:

http://www.nataliprize2009.eu

And a friend sent this, for journalists who pursue writing about health as a human right:

You have until July 31st 2009 to participate in the Lorenzo Natali Prize… don’t wait!

The Lorenzo Natali Prize is a competition organised by the European Commission. It rewards the journalists that have been dealing with issues such as democracy, human rights and the developing world.

For the first time this year, the Lorenzo Natali Prize is open to radio and television journalists.

If you have not applied yet… you have a few days left to fill in your application form.

To apply, you simply have to check the website http://www.nataliprize2009.eu and submit online your application.

Each applicant can submit ONE journalistic work or ONE extract of journalistic work published or aired between January 1st, 2008 and June 15th, 2009.

The seventeen winners of the Lorenzo Natali Prize will be guests of honour of the European Commission during a stay in Sweden. Each winner will receive a trophy and a prize. Overall, 60,000 euros of prize will reward the best works.

For further information or to apply, feel free to visit the website: www.nataliprize2009.eu

And . . .

“MDG” has been added to the “bad words” list. See why.

Issues here noted here — and afar

A FRIEND WRITES  . . .

 

Club Risky Business: HIV Prevention finally comes home?

By Mannasseh Phiri

 

LUSAKA, ZAMBIA — On the evening of Tuesday 16th June, the corridors leading to Ster Kinekor Cinema at Arcades were dressed for the Oscars – red carpet, lights, TV cameras to boot. The people – especially the women – walking the red carpet were dressed for the Oscars. The long colourful gowns were out.

 

The occasion was the launch of the TV mini-series called CLUB Risky Business – by the National AIDS Council, the Ministry of Health and donor funded agencies like Society for Family Health (SFH), Health Communications Partnership (HCP) and Zambia Centre for Communications Partnerships (ZCCP).

 

Club Risky Business is only one part and the beginning of a multimedia campaign called onelove – kwasila! – aimed at reducing the spread of HIV infections through multiple concurrent sexual partnerships (MCP).  It will air on ZNBC three times a week (one episode repeated) Monday, Wednesday and Fridays at 19:45 hrs and Muvi TV on Tuesdays at 21:30 and Saturdays at 19:00.

 

We have known since the beginning of the HIV epidemic in Zambia that HIV infections spread through the risky business of sex – especially risky unprotected sex with casual partners. As a result there have been many donor driven programmes to address and try to reduce risk ridden sexual behaviour.

 

More recently, and as we have come to know and understand our own HIV epidemic better, we have come to understand that what we have regarded as risky sexual behaviour is risky still, but it doesn’t make as significant a contribution to new HIV infections as what we have always regarded as ‘non-risky’ sexual behaviour. Sex in marriages and in regular long-lasting relationships has not, till recently, been regarded as risky business. Now we know that a much more significant number of new infections is taking place in marriages and other regular long term sexual relationships.

 

We have been concentrating our time, resources and attention in the wrong direction. No wonder new infections have continued so many years into the epidemic and despite all that is being done.

 

The story of Club Risky Business is centred on three ordinary everyday Zambian men, the women in their lives, their sexual behaviour, and a wise old barman called Sam, in a club (Club Risky Business) that they frequent and pour out their troubles and woes. Sam gives advice – and narrates their stories to the TV audience asking questions of the audience. It is clever and compelling TV, the likes of which we have not seen in Zambia before.

 

Club Risky Business brings the reality of the impact of multiple concurrent partnerships on people’s lives and on the direction of Zambia’s HIV epidemic.  It is not preachy or moralistic. It just tells the story of Zambian men and women in a way that every adult seeing the series will identify with – without embarrassment.

 

Finally in Zambia, we have HIV prevention being brought down from boardrooms and conference halls, from corridors of ministries and donor agencies – into where it belongs, and that is where most HIV infections take place – our homes. Finally the frank and open national conversation around HIV that those of us in HIV work have called for can begin to happen.

 

HIV Prevention has finally come home – our homes.

Mannasseh Phiri, M.D.

Chief Service Officer

Centre for Infectious Disease Research In Zambia (CIDRZ)

Mannasseh Phiri, M.D., is an HIV and AIDS activist, broadcaster and writer.

Researchers, Reporters Find Common Ground in Zambia’s Tuberculosis Epidemic . . .
LUSAKA, ZAMBIA — With at least 800 people out of every 100,000 living with tuberculosis in Lusaka alone, stories of this once-conquered disease surround us — everywhere except in the local news reports. And with the 7th highest rate of incidence of TB among HIV-positive people worldwide serving as a sign that a serious threat to public health is not being addressed where it can do the most harm, Zambia’s TB epidemic should be in the news.

That was the need that a joint Panos Relay, TARGETS AND ZAMBART workshop sought to address this week bringing researchers together with reporters to explore stories and the challenges to telling them.

The Wednesday and Thursday get-together at the Cresta Golfview Hotel included opportunities for journalists to talk off the record with researchers, and find common ground for what essentially can be a fruitful collaboration.
But you don’t need to have spent two days in a hotel conference room to reap the benefits of this event. For information on how to link with researchers who can help you tell Zambia’s TB stories contact:

• Gillies Kasongo at Panos: gillies@panos.org.zm
• Justin O’Brien at ZAMBART: justin@zambart.org.zm
• Alexandra Hyde at TARGET: alexandra.hyde@lshtm.ac.uk

Maternal health a human right . . .

With the Human Rights Council acknowledging that maternal mortality is a human rights issue, this is a great peg for a story on efforts to address the high rates of childbirth-related deaths in Zambia.

 

Another missing link in Zambia’s HIV response . . .

Problems addressing the link between HIV and injecting drug use are noted in Zambia’s midterm strategy report, so this mention in Lancet is timely, http://www.thelancet.com/journals/lancet/article/PIIS0140673609610928/fulltext?rss=yes

A Resource, Language, Reporting Contest . . .

A Celebration . . .

Getachew Bekele, Senior Advisor, Marie Stopes International

Family planning and reproductive health organization Marie Stopes International celebrated its first year in Zambia with an official launch, outlining its vision for its future work at the Taj Pamodzi Thursday. Ministry of Health spokesman Reuben Mbwewe was there to talk about the government’s interest in addressing unsafe abortions.

The organization, which provides a wide range of clinical services, is a gold mine for important newsworthy stories on sexually transmitted diseases, developments in contraception, male circumcision, infertility, access to safe abortion and cervical cancer, Zambia’s No. 1 cancer killer. Staffers will connect journalists with medical experts on to address myths and facts on these topics as well as clients willing to share the first hand experiences that bring stories to life.

Women waiting in the MSI outreach clinic in Chililalila. Kabwe, Zambia.

For information contact:

Alex Lemay, alex.lemay@mariestopes.org, tel: 0977948583

Weekend health

What’s in a name? A lot, Daily Mail journalist points out . . .

On Friday, the Daily Mail‘s “AIDS Matters” column once again gave another perspective, with a contribution from journalist and AIDS counselor Charles Chisala. The Times and Daily Mail AIDS columns have both done well in serving as a place for dialogue as well as commentary — with the Times running Chisala’s remarks last week, and the Daily Mail column, by Justin Mwiinga of the the National AIDS Column running responses to matters raised earlier.

In this contribution, Chisala eloquently raised on an important point — and raised the bar on thinking about what you write — with his comments on the use of the word “prostitute” to label women whose lack of resources puts them in the line of danger. The word as it is used in that context he points out is demeaning, dehumanizing, alienating and inaccurate.

“These women and girls have been forced into commercial sex work by circumstances created by the same society that is, through the media, stigmatising them,” Chisala wrote. “At a personal level, they are unable to confront the cruel system that has left them with nothing but their bodies to cling to for survival.”

Good thinking produces outstanding writing, this contribution shows, and Mwiinga deserves praise for providing the ongoing platform for thought-provoking dialogue.
It is on page 9 of Friday, June 5’s Daily Mail. And, in recognition of Chisala’s point, HealthWriter has added “prostitute” to the Health Desk bad word list. As always, you are invited to submit your own — printable — contributions to the list.

Environmental journalism contest:

Someone asked me recently if a story about an environmental issue counts as a health story. The answer is that environment is more often than not, at the root of factors that affect every aspect of health. Climate change, it has been noted, will affect where, how, and why populations will be exposed to both disease and essential resources. An upcoming contest will give journalists a chance to learn more.

The wave of the future brings cell phones and health tracking together

It sounds futuristic, but even while communities confront the basics of clean water and sanitation, cell phones can provide answers in today’s epidemics.

We use the word, but do we know what it means?

This New York Times article explores the struggle to define “pandemic.”

Stories From the Front Lines

And other useful information . . .

The value of commitment and wide-ranging knowledge when explaining health issues was exemplified this week by two responses to columns on AIDS policies. The first, noted here Friday, came from TALC’s Felix Mwanza, and took a critical — and personal —  look at U.S. President Barack Obama’s PEPFAR funding, as he answered an AIDS Matters column that appeared in the Daily Mail from the week before.

Then, on Sunday, journalist and HIV counselor Charles Chisala examined the other side of a proposal to criminalize HIV transmission, that had been discussed supportively in a Times  column the week before. The proposal sounds good, on the face of it — or at least without a downside. Chisala explains the downside, and in the process makes clear the importance of taking a multi-faceted look at apparently simple solutions.

He was able to do it because he knows his topic well enough to recognize gaps in information, pitfalls in reasoning and fallacies. While commentary columns and letters responding to them have more leeway than news and feature stories in putting forth a view of an issue, the combined results of columns and responses result were well-rounded views —  issues raised, premises laid out, and then challenged. in short the result was what good journalists strive for.

When health is covered regularly, questioningly and comprehensively that is what can happen. This blog is intended to help anyone who wants to do that.

To the right you will find links that can help you in a story — or in your career as a health reporter.  They include definitions and statistics, home pages for local and international health and journalism organizations, and recommended reading. Weekly updates will look at the local news as well as breaking research and reports that suggest local stories.

Also this week . . .

Speaking of reports outside the country, as articles here have largely and rightly touted the success of programs aimed at preventing mother to child HIV transmission, these reports point out some gaps, and make it clear that concrete efforts to address reproductive health, and health in general are needed for any HIV response to be effective.

This report from the International Treatment and Preparedness Coalition examines why efforts to prevent infants from becoming infected with HIV are falling far short of acheivable goals. It is must reading before covering another  PMTCT program.

In the meantime, this WHO report showing maternal and newborn death rates remaining high, underscores the need for efforts toward stronger health care infrastructures.

And with a second look at President Obama’s plans for global health, as well as fears for other donor funding, this report highlights the need for comprehensive health funding that can address rising tides of western-style illnesses — including hypertension, heart ailments and diabetes — in developing countries.

All of this suggests a story about the costs of accessible preventive health care in Zambia — and the costs of not having it.

Please send in your own comments, suggestions, updates. More next week.

Weekend Health

Did someone forget to celebrate Mothers Day? – The bad news this Mothers Day is that the rate of maternal mortality remains one of the highest in the world here, with 1,500 women in Africa dying every day for lack of emergency services. The good news is that with an American midwife and family health nurse conducting a WHO-funded study in Zambia and showing midwives and doctors at UTH an device she claims will reduce deaths from hemorrhaging during childbirth, we get another chance to look at one of Zambia’s most critical public health problems — and take a critical look at one proposed countermeasure. With every 100,000 births leading to the deaths of 1,000 women, the real question, of course is how health services can be structured so that childbearing doesn’t pose more real and lasting dangers to African women than the swine flu.

And . . . With a UNAIDS director calling Australia’s harm reduction strategies with injecting drug users a model for other countries, a follow on Zambia’s recently unveiled Mid-term National AIDS Strategy Review could be timely. The review calls for another look at the role of — and the toll on — injecting drug users in this country’s HIV epidemic

Health news raises questions

Scattered around all the leading newspapers today, health made the news — but some of the news raised more questions than answers.
That means fertile ground for followup stories.
For example: Both the Daily Mail and the Times cover the government’s call for a Health Professions Bill and quote officials saying the bill is a move to help practitioners deliver services. But details on how that will happen are sketchy, and in a country where 600 physicians struggle to meet the needs of nearly 12 million people, those details could be interesting.
In addition, the Times catches up to the Daily Mail in localizing swine flu concerns — mentioning the interesting finding that tourists landing at Livingstone International Airport were being screened for the sickness. A short feature on how this screening is done, and what tourists think of it would be a good read.
And, while the Times follows up on Zambia’s success in reducing malaria deaths, we still don’t know how many people have fallen ill, have died and will die from this preventable and treatable illness. In addition, a look at the effectiveness of different strategies would provide guidance for the public — and policy makers.
Finally, the IPS story in today’s Daily Mail: “TB: ‘Indeed Swaziland has a problem'” serves as a reminder that Zambia has a problem, too. With the 9th highest rate in the world for its rate of new cases and the 11th highest for its rate of deaths per 100,000 people in the world for its number of new cases (with most of its immediate neighbors having more). It is 7th for its incidence of TB among HIV positive people – a sign that a serious threat to public health is not being sufficiently addressed where it can spread the most quickly.