Friday, January 18, 2008
Afghanistan: Health Minister Calls AIDS Epidemic 'Serious And Alarming' Challenge
August 22, 2007 (RFE/RL) -- Afghanistan's Health Ministry announced on August 2 that HIV infections have increased fourfold in that country in the past six months. Official figures show 75 cases recorded this year, but international groups estimate that the real HIV-positive rate is higher. RFE/RL's Radio Free Afghanistan broadcaster Mustafa Sarwar discussed the Afghan AIDS epidemic with Health Minister Mohammad Amin Fatemi.
Friday, March 09, 2007
Licensing Opium in Afghanistan-Have They Thought About Its Public Health Consequences?
Licensing Opium in Afghanistan The British Medical Association and Senlis Councel, a Security and Development Policy Group recently called for licensing the poppy cultivation and using the opium produced in Afghanistan to make pain killer medicine for patients around the world. Diamorphine is derived from opium, used as a pain killer medicine for patients after surgeries and for patients suffering from AIDS. The British Medical Association suggests that it will help both the farmers in Afghanistan as well as patients in Britain who suffer from unmanageable pain due to surgery. Senlis Council, a US based think-tank organization also encourages control licensing of opium in Afghanistan for almost the same reason of helping patients suffering from severe pain around the world. Although, it seems a very legal issue and people ignore the public health part of the discussion. However, I believe that the licensing of poppy cultivation will not only encourage the production of opium and heroin, but it will also increase the addiction rate in Afghanistan, which is a great public health threat.
Afghanistan is a country in central Asia with a population of estimated 23,850,000 (UN) with a history of war and conflict since 1978 after the Soviet Occupation. The Soviet occupation followed with a civil war and ended with the rule of Taliban during 1995-2001, which was a dark period of Afghan history. Poppy cultivation and opium production have been a concern in Afghanistan since then. The numbers of addicts increases day by day in the country. According to survey conducted by the United Nation Office on Drug and Crime (UNODC) in 2005 the status of drug addiction in Afghanistan was as follows: Estimated poly drug users: 920,000 (3.8% of total population) from which 60,000 are children >15 and 121,000 are women (UNODC 2005). Habitually, opium is used in Afghanistan for different purposes such as medication, pleasure, etc. People in almost all parts of the country use small amount of opium as a traditional medicine to control pain. In addition, mothers who work in the farms or weaving carpets, especially in the northern part of the country use opium to sedate their children, while they work. The kids will later in their lives become addicted to the drugs. There are families addicted to opium around the country, specifically in northern part of the country. The number of drug addicts are increasing day by day and this happens, when there is so-called restriction to poppy cultivation and opium production by the government, but to license the opium production in a country such as Afghanistan where there is no control of government would be a disaster for the health of the public.
The method for harvesting opium in Afghanistan is very unprofessional; the problem with it is that the tools they use are very basic. They scrap the opium by a metallic tool, and in order to accommodate enough raw opium on the tool they use their wet fingers (thumbs) by licking them and push the opium. Consequently, it causes unintentional toxicity and addiction. Therefore, to control the method of harvesting is a big question. Furthermore, most of the field workers who harvest opium are children and women. Women and children are the most vulnerable section of population to disease, disasters, etc around the world and Afghanistan is no exception. Indeed, women and children are at high risk of toxicity and addiction while they work in the field, therefore, licensing opium production means putting more women and children in danger.
One of the most important aspects of ethical issues is the human rights, our social, mental, and physical well-being will be affected by violation of human rights, while promoting and protecting basic rights of human can directly affect the promotion and protection of health2, (Childress et al. 2002) for example in principle nine of declaration of the rights of the child says “The child shall be protected against all forms of neglect, cruelty and exploitation. He shall not be the subject of traffic, in any form.” “The child shall not be admitted to employment before an appropriate minimum age; he shall in no case be caused or permitted to engage in any occupation or employment which would prejudice his health or education, or interfere with his physical, mental or moral development”3 (http://www.unhchr.ch/). This principle can be undermined with the above-mentioned proposal of licensing opium in Afghanistan, because a big number of children are involved in labor for opium farms. We actually put millions of people especially children and women in danger in order to help others. The British Medical Association argue that "If we actually were harvesting this drug from Afghanistan rather than destroying it, we'd be benefiting the population of Afghanistan as well as helping patients and not putting people at risk.” However, the risk would be greater than the present, which put thousands and millions of people in danger of opium. In order to fulfill ones need, we have to balance between the needs.4 (O'Rourke 2000). It is not wise to fulfill our needs by putting other people in danger. To accomplish the need of the critically ill patients around the world, we should not forget our social need to be fulfilled and put those innocent people in danger of toxicity and addiction.
Proponents of legalization of opium argue that “One of the key provisions for the establishment of a licensing system requires that ‘prohibition’ of poppy cultivation should be enforced if prevailing conditions make prohibition the most suitable measure to reduce the risk of diversion into the illegal heroin market and to protect public health. However, under the current drug policy regime, 100% of opium produced is diverted. At the same time, current counter-narcotic strategies themselves have failed to protect and have even led to the undermining of public health and welfare.” They also argue that “The risk of diversion exists but it would be minimal compared with 100% diversion occurring under current system.” However, I believe that even if by controlling the diversion of opium decrease by 50% by implementing such strategy, while the production increase by 100 to 150% in the country is not very positive about the program.
To summarize, control licensing of poppy cultivation and opium production in Afghanistan will be a danger to the health of Afghan people, because once the drug production is licensed, even if it is for the medical purposes, can be a great threat to the public’s health. It will increase the number of addicts in the country, put children and women in the first line of danger.
References:
1. United Nations Office on Drug and Crime, “Afghanistan Drug Use Survey” 2005.
2. J.D. Childress et al, “Public Health Ethics: Mapping the Terrain,” Journal of Law, Medicine and Ethics, 30, 2 (2002), pp. 170-178
3. Declaration of the Rights of the Child Proclaimed by General Assembly resolution 1386(XIV) of 20 November 1959, www.unhchr.ch/html/menu3/b/25.htm, Accessed 14, February 2007.
4. Kevin O’Rourke, “What is Health Care Ethics?,” in K. O’Rourke (Ed.) A Primer for Health Care Ethics, Essays for a Pluralistic Society (Washington, DC: Georgetown University Press, 2000), pp. 2-9
Afghanistan is a country in central Asia with a population of estimated 23,850,000 (UN) with a history of war and conflict since 1978 after the Soviet Occupation. The Soviet occupation followed with a civil war and ended with the rule of Taliban during 1995-2001, which was a dark period of Afghan history. Poppy cultivation and opium production have been a concern in Afghanistan since then. The numbers of addicts increases day by day in the country. According to survey conducted by the United Nation Office on Drug and Crime (UNODC) in 2005 the status of drug addiction in Afghanistan was as follows: Estimated poly drug users: 920,000 (3.8% of total population) from which 60,000 are children >15 and 121,000 are women (UNODC 2005). Habitually, opium is used in Afghanistan for different purposes such as medication, pleasure, etc. People in almost all parts of the country use small amount of opium as a traditional medicine to control pain. In addition, mothers who work in the farms or weaving carpets, especially in the northern part of the country use opium to sedate their children, while they work. The kids will later in their lives become addicted to the drugs. There are families addicted to opium around the country, specifically in northern part of the country. The number of drug addicts are increasing day by day and this happens, when there is so-called restriction to poppy cultivation and opium production by the government, but to license the opium production in a country such as Afghanistan where there is no control of government would be a disaster for the health of the public.
The method for harvesting opium in Afghanistan is very unprofessional; the problem with it is that the tools they use are very basic. They scrap the opium by a metallic tool, and in order to accommodate enough raw opium on the tool they use their wet fingers (thumbs) by licking them and push the opium. Consequently, it causes unintentional toxicity and addiction. Therefore, to control the method of harvesting is a big question. Furthermore, most of the field workers who harvest opium are children and women. Women and children are the most vulnerable section of population to disease, disasters, etc around the world and Afghanistan is no exception. Indeed, women and children are at high risk of toxicity and addiction while they work in the field, therefore, licensing opium production means putting more women and children in danger.
One of the most important aspects of ethical issues is the human rights, our social, mental, and physical well-being will be affected by violation of human rights, while promoting and protecting basic rights of human can directly affect the promotion and protection of health2, (Childress et al. 2002) for example in principle nine of declaration of the rights of the child says “The child shall be protected against all forms of neglect, cruelty and exploitation. He shall not be the subject of traffic, in any form.” “The child shall not be admitted to employment before an appropriate minimum age; he shall in no case be caused or permitted to engage in any occupation or employment which would prejudice his health or education, or interfere with his physical, mental or moral development”3 (http://www.unhchr.ch/). This principle can be undermined with the above-mentioned proposal of licensing opium in Afghanistan, because a big number of children are involved in labor for opium farms. We actually put millions of people especially children and women in danger in order to help others. The British Medical Association argue that "If we actually were harvesting this drug from Afghanistan rather than destroying it, we'd be benefiting the population of Afghanistan as well as helping patients and not putting people at risk.” However, the risk would be greater than the present, which put thousands and millions of people in danger of opium. In order to fulfill ones need, we have to balance between the needs.4 (O'Rourke 2000). It is not wise to fulfill our needs by putting other people in danger. To accomplish the need of the critically ill patients around the world, we should not forget our social need to be fulfilled and put those innocent people in danger of toxicity and addiction.
Proponents of legalization of opium argue that “One of the key provisions for the establishment of a licensing system requires that ‘prohibition’ of poppy cultivation should be enforced if prevailing conditions make prohibition the most suitable measure to reduce the risk of diversion into the illegal heroin market and to protect public health. However, under the current drug policy regime, 100% of opium produced is diverted. At the same time, current counter-narcotic strategies themselves have failed to protect and have even led to the undermining of public health and welfare.” They also argue that “The risk of diversion exists but it would be minimal compared with 100% diversion occurring under current system.” However, I believe that even if by controlling the diversion of opium decrease by 50% by implementing such strategy, while the production increase by 100 to 150% in the country is not very positive about the program.
To summarize, control licensing of poppy cultivation and opium production in Afghanistan will be a danger to the health of Afghan people, because once the drug production is licensed, even if it is for the medical purposes, can be a great threat to the public’s health. It will increase the number of addicts in the country, put children and women in the first line of danger.
References:
1. United Nations Office on Drug and Crime, “Afghanistan Drug Use Survey” 2005.
2. J.D. Childress et al, “Public Health Ethics: Mapping the Terrain,” Journal of Law, Medicine and Ethics, 30, 2 (2002), pp. 170-178
3. Declaration of the Rights of the Child Proclaimed by General Assembly resolution 1386(XIV) of 20 November 1959, www.unhchr.ch/html/menu3/b/25.htm, Accessed 14, February 2007.
4. Kevin O’Rourke, “What is Health Care Ethics?,” in K. O’Rourke (Ed.) A Primer for Health Care Ethics, Essays for a Pluralistic Society (Washington, DC: Georgetown University Press, 2000), pp. 2-9
Sunday, February 25, 2007
Afghanistan to slaughter birds after suspected H5N1 cases
AFP - Afghanistan will slaughter birds in areas where two cases of bird flu are suspected of being the H5N1 strain that is potentially fatal to humans, the Food and Agriculture Organisation said.
Monday, November 06, 2006
ROLE OF TRAINED TRADITIONAL BIRTH ATTENDANTS (TBAS) IN REDUCTION OF MATERNAL MORTALITY IN AFGHANISTAN
High Maternal Mortality Ratio (MMR) is a challenge a head of the Ministry of Public Health of Afghanistan. The MMR is very high in Afghanistan, 1900/100,000 (UNICEF, 2004) live births and in Badakhshan of Afghanistan it is the highest ever recorded in the world, 5600/100,000 live births (UNICEF 2002). Yet the role of TBAs in reduction of MMR has become less important and training TBAs has been stopped by the World Health Organization, UNICEF, and the Ministry of Public Health. I strongly believe that TBAs can still play a vital role in the reduction of MMR by the provision of safe and clean delivery with extensive supervision and a marginal incentive, which is cost effective, identification of early danger signs of pregnancy and referral of mothers to Emergency Obstetric Care centers.
Globally speaking about Maternal Mortality Ratio around 585, 000 maternal deaths happening every year through out the world mainly in developing countries (Gijs et al 1999). The main causes of these deaths are five major complications of delivery such as: hemorrhage, infections, high blood pressure, obstructed labour and unsafe abortion, which can easily be prevented by provision of comprehensive maternal care system at the community and district level. Home deliveries are high in percentage in Afghanistan conducted either by a Untrained Traditional Birth Attendant or relatives without assistance of professional health worker. Safe and clean delivery is very important for each delivery and training those TBAs who is the only mean of assistance in terms of delivery for the majority of women in the country can be vital. Provision of marginal incentive for Trained TBAs is a good strategy for encouraging them to do a better job and it is much cost effective than provision of professional health worker with midwifery skills for each delivery all over the country. In a country of 25,000,000 people where 78% (www.prb.org)of the population live in rural areas without basics of life and health care. To provide health professional with midwifery skill to attend all deliveries, there is a need to train 8,000 midwives and they will not only need salary, but also housing, education for their children and job for their husbands, which can be too costly, while we need 16,666 TBAs if each covering a population of1500.
Five major causes of Maternal Mortality such as hemorrhage, infections, high blood pressure, obstructed labour and unsafe abortion, which could be prevented if the danger signs are early diagnosed by the TBAs who is the first and for most of the mothers in the country the only source of basic care. Therefore training and extensive supervision of the TBAs with the marginal incentive can assure best performance of the TBAs. "According to a recent study, more than 40 per cent of deaths among women of child-bearing age are caused by complications in pregnancy that are preventable" (www.unicef.org/afghanistan). On the other hand in the past TBAs haven't been successful and effective in reduction of MMR, because they have been volunteers and volunteerism in Afghanistan is challenging strategy to achieve the most from the people. Early diagnosis of danger signs and referring the mothers to higher level of Obstetric Care remain vital for the pregnant mothers.
Referral of mothers once the danger signs are diagnosed to the next level of care with more comprehensive obstetric care, rarely available, is another issue and it is difficult to achieve. The economical condition of the families is not at the level that they could transfer their patients to higher levels, which is mainly available only in the cities. In addition the terrain in the country prohibits most of the people to reach to the basic health care, especially during the winter. Furthermore transport is still an issue in the country. Taking the above issues into consideration if we stop training TBAs who is the first and the only contact for most of the women to help them diagnose the danger signs in advance and give them time to reach the next level of care at least few days earlier than delivery day would be a disaster for them.
In conclusion, TBAs can play a significant role in reduction of the Maternal Mortality Rate in Afhganistan if they are well trained and extensively supervised. Moreover the TBAs should be allocated a marginal incentive in order for them to be encouraged to do their job in a proper manner.
Globally speaking about Maternal Mortality Ratio around 585, 000 maternal deaths happening every year through out the world mainly in developing countries (Gijs et al 1999). The main causes of these deaths are five major complications of delivery such as: hemorrhage, infections, high blood pressure, obstructed labour and unsafe abortion, which can easily be prevented by provision of comprehensive maternal care system at the community and district level. Home deliveries are high in percentage in Afghanistan conducted either by a Untrained Traditional Birth Attendant or relatives without assistance of professional health worker. Safe and clean delivery is very important for each delivery and training those TBAs who is the only mean of assistance in terms of delivery for the majority of women in the country can be vital. Provision of marginal incentive for Trained TBAs is a good strategy for encouraging them to do a better job and it is much cost effective than provision of professional health worker with midwifery skills for each delivery all over the country. In a country of 25,000,000 people where 78% (www.prb.org)of the population live in rural areas without basics of life and health care. To provide health professional with midwifery skill to attend all deliveries, there is a need to train 8,000 midwives and they will not only need salary, but also housing, education for their children and job for their husbands, which can be too costly, while we need 16,666 TBAs if each covering a population of1500.
Five major causes of Maternal Mortality such as hemorrhage, infections, high blood pressure, obstructed labour and unsafe abortion, which could be prevented if the danger signs are early diagnosed by the TBAs who is the first and for most of the mothers in the country the only source of basic care. Therefore training and extensive supervision of the TBAs with the marginal incentive can assure best performance of the TBAs. "According to a recent study, more than 40 per cent of deaths among women of child-bearing age are caused by complications in pregnancy that are preventable" (www.unicef.org/afghanistan). On the other hand in the past TBAs haven't been successful and effective in reduction of MMR, because they have been volunteers and volunteerism in Afghanistan is challenging strategy to achieve the most from the people. Early diagnosis of danger signs and referring the mothers to higher level of Obstetric Care remain vital for the pregnant mothers.
Referral of mothers once the danger signs are diagnosed to the next level of care with more comprehensive obstetric care, rarely available, is another issue and it is difficult to achieve. The economical condition of the families is not at the level that they could transfer their patients to higher levels, which is mainly available only in the cities. In addition the terrain in the country prohibits most of the people to reach to the basic health care, especially during the winter. Furthermore transport is still an issue in the country. Taking the above issues into consideration if we stop training TBAs who is the first and the only contact for most of the women to help them diagnose the danger signs in advance and give them time to reach the next level of care at least few days earlier than delivery day would be a disaster for them.
In conclusion, TBAs can play a significant role in reduction of the Maternal Mortality Rate in Afhganistan if they are well trained and extensively supervised. Moreover the TBAs should be allocated a marginal incentive in order for them to be encouraged to do their job in a proper manner.
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