Ethiopia: Family planning

as decision

The Pharmacist Solomon Betre, 56, has advised customers from all strata of society in the field of family planning in his two pharmacies in Addis Ababa. According to his experiences in Ethiopia contraception is a question of education and income.

Shanty Town in the center of Addis Ababa. About three and a half million people live in Ethiopia’s capital, most of them bitterly poor. Two thirds of the population can neither read nor write. Due to periodic drought, many people are malnourished.

In the course of reforming the Ethiopian health system consulting in the field of family planning and access to contraceptives have been improved. Bertukan Michael, 50, mother-child sister for over thirty years, is proud that as a result contraception is practiced much more frequently today.

Women who want to avoid long waiting times in the public health centers or are prevented during their opening times, also get competent advice in pharmacies. Besides pills pharmacists offer other contraceptives. So every woman can adjust their method of contraception to their circumstances.

According to WHO estimates from the year 2012 more than 200 million women in developing countries want reliable contraception, but have no access to it. To change this, the pharmacist Nemayehu Dhabu, 28, sells his customers contraceptives at an affordable price.

Fikirte Disasa, 22, has deliberately prevented conception and had her six month old son only after completion of her education. According to the United Nations family planning is urgently needed. It strengthens the position of women, reduces child mortality and improves maternal health.

Fatuma Aman’s husband rejects contraception, although the economic situation of the family currently does not allow children. While women today are increasingly concerned with family planning, many men still do not want to deal with it.

Ethiopia: Women

and contraception

Sy Nuy Talib, 24, is one of over 38,000 graduates of a yearlong training for health consultants. Like her colleagues, who are predominantly appointed in the country, she advises families on health issues and in the field of family planning.

Tefetawit Gebre Aregawi, 24, works as a health officer in one of the health centers of Adama. She coordinates the work of the mobile health counselors, advises patients and provides them with free medications.

Family planning is a cultural and religious taboo in Ethiopia. That is why Tefetawit first approaches the women who come to her at the human level, before she talks to them about contraception.

Most Ethiopians live in a vicious circle of poverty, lack of education and unwanted pregnancies. Many have no access to contraceptives, some reject contraception for fear of infertility and side effects. Mobile health counselors like Sy Nuy do important educational work here.

Nurse Melkanu Rideper, 25, works in a Marie Stopes clinic in Addis Ababa. It is a haven for unintentionally pregnant women who decided upon abortion, although this is socially not accepted and it is legal only under certain circumstances.

South Africa: Tuberculosis

Sindiswei, 27, is wearing a surgical mask because she is suffering from tuberculosis. This infectious bacterial disease usually affects the lungs in humans. It is transmitted by droplet infection already by speaking, sneezing or coughing.

Professor Andreas Diacon of the University of Stellenbosch in Cape Town researches new tuberculosis therapies. The disease was considered eradicated in many parts of the world. But due to a lack of controls and resistant bacterial strains, it became a global threat again.

Alando Adams, 25, has tuberculosis. In his native South Africa the disease is the main cause of death. Worldwide every second a new person picks up the disease. Already a third of the world population is latently infected with tuberculosis.

Gabiba Daniels, 40, lives in a slum of Cape Town. She is a good example that tuberculosis often hits the poorest of the poor. Despite her illness she does not wear a surgical mask and thus represents a major threat to the people around her.

Taharqa Elnour, 27, an employee of Professor Diacon, recruits participants for TB trials. Most come from the relocation camp Blikkiesdorp. Here, 14,000 people in poor physical condition live in 1700 crowded, windowless, barely ventilated shacks. Circumstances which make the camp an incubator for tuberculosis.

Because of abandoned treatments, insufficient supply of drugs and uncontrolled use of antibiotics, some species of mycobacteria were able to develop resistance against conventional drugs for the treatment of tuberculosis. With his team, the Task Applied Science, Professor Diacon therefore researches new therapies.

Uganda: African

sleeping sickness

Moses, 28, farmer, was infected with the African sleeping sickness by the bite of a tsetse fly. Thanks to a new therapy he will be right back to health in one to two years. Then he can support his family as usual in the cultivation of maize and cassava.

Olema Erphas, 38, is director of a health center in north-western Uganda. There he treats many people who suffer from the African sleeping sickness. Doctors who are less familiar with the disease, often misinterpret it‘s symptoms such as headache, joint pain, fever and fatigue. The resulting improper treatment can lead to death of the patient.

Yusuf, 35, farmer, was bitten by a tsetse fly and infected with the African sleeping sickness in 1993. The fly lives mainly where the farmers cultivate their fields: in moist, densely vegetated riparian areas.

Nine-year-old Adomaté suffers from the typical symptoms of African sleeping sickness. She sleeps almost continuously, can hardly move, does not speak or eat. Meanwhile she has lost so much weight that she is nothing but skin and bones.

Adomatés parents searched for years for a competent doctor. Since the girl is treated with the new combination therapy by Olema Erphas at the health center of Omugo, her condition has improved significantly. Nevertheless, it will still take a while until she will recover.

In order to find a better treatment for African sleeping sickness, closely monitored clinical studies have been conducted at the health center of Omugo. Nurse Sanda Tuteu, 44, is proud that she could help to develop a therapy with fewer side effects and shorter duration of treatment.

The widespread West African form of sleeping sickness can be successfully treated with a combination therapy of the active substances nifurtimox and eflornithine today. Even the eight year-old Samuel has received this therapy and is almost healed now.

The superstition African sleeping sickness is caused by our own misconduct is widespread in Uganda. Sufferers are often seen as bewitched and are avoided. And yet the support of friends and family, as Moses experienced it, is especially important to survive the fight against the disease.

Congo: the fight

against HAT

Dr. Crispin Lumbala is a physician, disease-control expert, and Director of the National Program for Control of Human African Trypanosomiasis (HAT) in the Democratic Republic of the Congo. As the coordinator of the National Congolese Program for the Control of Sleeping Sickness, he is responsible for overall logistics in all the provinces of the country.

Humans and the tsetse fly share the same needs and preferences: water and shade. They both prefer to live near river courses with dense vegetation. Places where people cultivate their fields near the water, fish from the shore, wash their clothes or search for diamonds in the Congo – these are also places where the tsetse fly lays its larvae in the ground.

HAT patients at Bandundu Ville hospital taking Lampit, one component of Nifurtimox-Eflornithin combination therapy (NECT) for the second, more severe stage of the disease.

Mushie resident on her way to the public water pipe to wash dishes. The best way to access Mushie is by boat: approximately 15,000 kilometers of the Congo and its tributaries are navigable, as are the Kwilu, the Kwango and the Kasai, via which you can travel to Mushie.

The hospital in Mushie was built by the Belgians during the colonial period. Relatives are on hand to look after the patients, cook for them and wash their laundry. This means that not only the patients themselves are no longer available to work, but also family members.

Nsole Bompina (m.), fisherman infected with HAT, with his sister Isumu and brother Lokua, who paddled him to the hospital by dugout canoe in a fourteen-hour journey. He is greatly marked by the disease. His brother and sister wash and feed him every day, putting a total of three of the family's breadwinners out of action.

Announcer from the mobile intervention team in Ngantoko. The aim is not only to spread the news, but also to help overcome economic, psychological and cultural resistance among the population, because in Africa diseases are often thought to be related to a curse, a malediction or a sin.

Inhabitants of Ngantoko village report to the secretary of the mobile intervention team to have the HAT test; they leave their personal data and subsequently have a blood sample taken. All those who are willing to take part give the secretary their name and date of birth; he then gives them a small control slip and sends them to the second stage of the screening process.

The CATT, the Card Agglutination Test for Trypanosomiasis, determines whether a person has come into contact with trypanosomes and has developed antibodies. If the tested person's blood contains trypanosomiasis antibodies, the cells can be seen to clump together (agglutinate) after a while. The test is then positive; however, this does not mean that the person definitely has HAT.

Lola Ngafutu, a farmer, with two of her six children. In the absence of her husband, she refuses to have the lumbar puncture that could confirm that she is now healthy again. However, the chances that Lola really is cured are good in this case, because the baby on her arm was born after her treatment and is healthy.

Alexandre Mbukatoto, medical director of the mobile intervention team in Kutumpay, is convinced: "We bring the techniques for fighting the disease and for early detection to places where there are no clinics and the population is very poor. The fight against trypanosomiasis would be impossible without the mobile intervention teams!"

Chagas in Argentina

Dr Jaime Altcheh, paedriatic doctor and head of the department for parisotology and Chagas disease in his office at the paedriatric hospital Ricardo Gutierrez in Buenos Aires. He believes that Chagas is a children’s disease: “An infected adult is a child that went untreated! Most infections are caused in childhood.”

Chagas is transmitted primarily by vectors, living orgasnisms that transfer the pathogen from one infected organism to another. The transmitting vector of chagas disease is a nocturnal blood-sucking bug named Triatoma infestans, in colloquial language often called “Vinchuca”.

Ester Contreras, patient at the National Institute for Parasitology in Buenos Aires, used to live in a rural area and didn’t know much about Chagas until her diagnosis. Most uninformed Chagas patients take up a very easygoing attitude towards their infection until it reaches its chronic stage and they start having symptoms.

Dr Claudia Domínguez, a specialist for prenatal infections, works in a public clinic, the Lagomaggiore Hospital in Mendoza, one of the six regions worst affected by Chagas disease. She explains that people living in the endemic zones run the highest risk of infection, but most children under fifteen have contracted the disease from their mothers during pregnancy.

This family offers a perfect example of how Chagas disease is transferred from mother to child during pregnancy: All female relatives of the eight-year-old Alejandra and her grandmother Mercedes are infected. They all live far away from the next hospital and medical care in Mendoza which makes getting an appointment very time-consuming and expensive.

In endemic areas most of the people live in old straw-roof adobe houses with free access and perfect hiding-places for vinchucas. Though this house also looks like a run-down shack, it is in far better condition than many of the other ones. Here Daiana Ruiz’ family feels safe from vinchucas and thus from Chagas disease.

Daiana Ruiz, 17, holding her newborn, is sitting in the kitchen with her sister and mother-in-law. She and her child had a successful medical treatment of their Chagas infection. The younger the patient is, the better their chances of recovery. That’s why the need for a paedriatric formulation of the medicine nifurtimox is extremely high.

Jorge Nasir, manager of the vector-control program in Santiago del Estero, coordinates three hundred staff, thirty-six delivery vans, forty motorbikes and the necessary funds to defeat the Chagas-vector, the so-called vinchuca. This privilege has been achieved by convincing the province’s governor of the necessity to properly fund the program.

The vector control team is monitoring all houses so closely in order to prevent further contagion. They also record GPS coordinates and analyze all detected vinchucas. Alejandro, an old farmer, is very thankful and overwhelmed by all the effort being expended because of his health.

Equipped with protective suits, helmets, breathing masks and gloves the vector monitoring team treats the houses inside and outside, using chemical substances derived from pyrethroids which are not harmful to human health or animals. They literally comb through all houses looking for vinchucas.

Also part of the national Chagas program are mobile educational teams informing the rural population of the affected regions about Chagas. They visit about 1,800 small rural schools, teaching schoolchildren about the infection, risks and consequences of the disease, an information they hopefully share with their families at home.

Dr Ledesma Patiño has spent over 45 years combating the disease but still is emotionally overwhelmed when talking about the tragic fortunes of those who are infected. But he’s very proud of the achieved progress: The incidence rate among schoolchildren is now only around 1 to 1.2 per cent, while the number of new infections is even less.

To improve people’s lives in endemic countries like Argentina a lot of action has to be taken. Educating doctors and society about the treatment and possible cure of Chagas disease is one of the big challenges in the fight against one of the greatest scourges to afflict Latin America.