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Archive for December 14th, 2010

Kenya teetering on the edge of a colossal cancer disaster

Posted by Administrator on December 14, 2010

Dr Peter Kagotho of the cancer section at the Kenyatta National Hospital prepares a patient for therapy. The two outdated Cobalt 60 machines in use at the hospital cannot adequately meet the needs of the swelling list of patients referred to the facility, and medical specialists in the private sector argue that, at the moment, the country has few specialist cancer surgeons. This means that some of the work best handled by specialists is left to general surgeons, who operate on a broad range of diseases and conditions, especially in provincial and district hospitals.

Dr Peter Kagotho of the cancer section at the Kenyatta National Hospital prepares a patient for therapy. The two outdated Cobalt 60 machines in use at the hospital cannot adequately meet the needs of the swelling list of patients referred to the facility, and medical specialists in the private sector argue that, at the moment, the country has few specialist cancer surgeons. This means that some of the work best handled by specialists is left to general surgeons, who operate on a broad range of diseases and conditions, especially in provincial and district hospitals.

The cancer situation in Kenya is worrying and is characterised by a rapidly growing demographic of new cases and few treatment and management opportunities.

This dark reality came to the fore after a mission from the International Atomic Energy Agency (IAEA) visited the Kenyatta National Hospital in June. The daunting report born of that visit was released recently.

“The cancer situation in Kenya is dire,” the IAEA audit reads in part, “with a severe lack of medical practitioners and a large number of new cancer cases being diagnosed annually.”

The IAEA may strike a familiar chord in the minds of many Kenyans, especially because of its activities in containing the nuclear arms threat in North Korea and Iran. But as cancer spreads its malignant effects in Kenya, all indications point to a bigger and more prominent presence of the agency on Kenyan soil.

Diagnostic kits

Apart from controlling nuclear arms proliferation, the organisation is also a leader in the production of diagnostic kits and the treatment of some cancers.

The June mission, the first of its kind in the region, was aimed at “establishing a sound understanding of where Kenya stands in its attempt to control cancer, and what measures must be taken to ensure that the best possible treatment, prevention, and care measures will be available to all of citizens in the future,” according to the IAEA.

The task ahead is huge, no doubt, but experts have already embarked on the long voyage, says Prof N.A. Othieno-Abinya, head of oncology at the Aga Khan University Hospital and chairman of the Cancer Research and Communications Organisation.

“Although we don’t have reliable local data, we have started to record increasing cases of cancer in our hospitals,” said the consultant in a recent interview with DN2.

But despite the lack of reliable data, he says, two things are clear; cancer is not necessarily a disease of the rich, and that those who seek treatment do so quite late, when treatment is expensive and, generally, not curative.

Prof Othieno-Abinya, who also co-chairs a committee of the African Organisation for Research and Training in Cancer, advises Kenyans to adopt a routine screening culture so that the disease can be diagnosed early.

“Cancer seems to be running ahead of us,” he warns, adding that the Aga Khan University Hospital is already putting up a modern, appropriately equipped cancer screening and treatment centre.

A comprehensive cancer policy for the country has for years been crawling along the bureaucratic corridors and, as it trudges along, it will come out to the agonising reality that the only two therapeutic radiotherapy machines at the Kenyatta National Hospital are way past their use-by date.

The government has finally acknowledged that cancer poses a real threat to its people and, by extension, the economy. A paper it prepared specifically for the IAEA on the cancer situation in Kenya contends that, while a lot more needs to be done, something is already happening.

That “something” includes the recent adoption of the Alcoholic Drinks Control Act, 2010, which aims to restrain the consumption of alcoholic beverages in the country. The Act is relevant in the fight against cancer because alcohol has been found to be a major risk factor for cancers of the mouth and throat.

Biggest percentage

A study by the Kenya Medical Research Institute (Kemri) found that, of the 2,292 cancer-related deaths recorded in Nairobi during a two-year period, oral tumours claimed the biggest percentage of victims.

“Of these, cancer of the oesophagus was the leading cause of death, accounting for 10 per cent (236) of all cancer-related deaths,” says Joseph Omach of the Cancer Research and Communications Organisation, and who has been involved in compiling cancer registry data at Kemri.

Research also indicates that people who develop a liver condition called cirrhosis, in many cases caused by too much alcohol and hepatitis B and C viruses, can develop liver cancer. And women who take more than three alcoholic drinks a day increase their risk of breast cancer.

To complement the new alcohol law in the anti-cancer crusade is the recently passed anti-tobacco Bill, the government says. This is because smoking has also been identified as a major risk factor for cancer, and accounts for almost 30 per cent of all cancer-related deaths worldwide.

Poor facilities

But this two-pronged campaign is likely to be hampered by the dismal availability of facilities in the country, a capacity that would otherwise help hospitals mitigate against the effects of the disease on the population.

The Kenyatta National Hospital plans to replace one of its decommissioned radiotherapy machines by 2011, even though this will hardly give the country any additional capacity to handle the current demand.

This leaves the private sector to take up the challenge. The Cobalt 60 machines used by KNH are the remnants of an old generation, and are equipped with limited capability to optimally treat complex cases. The only centre in the country with newer technology, called Linear Acceleration, is the Cancer Care Unit at the MP Shah Hospital in Nairobi.

But, while this technology is more accurate and handles a higher load than Cobalt 60, it is much more expensive and has very high maintenance demands.

“The machines require a resident engineer and, at the moment, we don’t have such a trained person in the region,” explains Prof Othieno-Abinya.

The installation of two such machines at the Aga Khan University Hospital, planned for early next year, will give Kenya the biggest cancer radiology capacity in Eastern and Central Africa.

The facility will provide wide-ranging treatment in both cardiology and cancer, including radiation therapy and open heart surgery.

“We have to make sure that we get it right by having the right personnel, equipment, and specialised buildings to house these technologies,” says Prof Othieno-Abinya.

However, radiology equipment is only part of the struggle against cancer since not all tumours require this kind of treatment.

“For example,” explains Prof Othieno-Abinya, “Bukitt’s lymphoma, which is a major problem around the lake region and at the Coast, is so aggressive that you can hardly use radiotherapy to cure it. Only appropriate chemotherapy can work.”

Most cancers, he says, require a combination of treatments involving chemotherapy, radiotherapy, and surgery.

A good cancer policy will require an effective drug regulatory authority that ensures that patients get the most effective treatments “because this is not a hit-or-miss disease”.

“A miss may not allow a second chance, and that may cost you a life. However, the high cost of cancer drugs — and cancer care as a whole — needs to be addressed,” says Prof Othieno-Abinya.

Spurred by the growing cases of cancer across the country, the Ministry of Medical Services has made public its plans to open specialist centres in all provincial hospitals. Currently, some patients have to travel more than 600 kilometres to Nairobi, only to be put on an eight-month waiting list.

Medical specialists in the private sector argue that, at the moment, the country has very few specialist cancer surgeons. This means that some of the work best handled by specialists is left to general surgeons who operate on a broad range of diseases and conditions, especially in provincial and district hospitals. This, of course, means that cancer patients are not afforded the opportunity to get quality care.

Dr Jessicah Wambani, chairperson of the Kenya Radiation Protection Board, says there is no academic institution in the country that offers medical physics as an area of study. “The five medical physicists we have were trained abroad,” she told an IAEA publication recently.

And, in a brief to the IAEA, the government says several medical doctors from provincial hospitals have already been seconded to KNH for training as radiation oncologists, while therapy technologists have been recruited for placement in peripheral cancer care centres.

On the flip side, the advent of more radiology machines and other recent diagnostic and imaging technologies presents Kenya with a new problem; that of over-exposure to radiation for medical staff as well as the use of old machines that may not guarantee the correct dosages to patients and users.

There has been an explosion in Kenya of many radiation-using medical facilities, such as CT (computed tomography) scanners, MRI (magnetic resonance imaging) machines as well as ultrasound services, without a corresponding training of technical staff.

According to the IAEA, Kenya has about 5,000 workers in radiation-related jobs at 600 medical facilities. However, only about a quarter of these nurses, patient assistants, dentists, radiographers, and radiologists are monitored for exposure.

“We don’t have national guidelines and standards in diagnostic radiology in Kenya… because we don’t have enough data due to lack of funds,” Dr Wambani told the IAEA.

The agency is working with the KNH and the Moi Teaching and Referral Hospital, Eldoret, to gather radiology dose information to create reference levels for Kenya.

And Dr Wambani says attempts are being made to expand the project to all the hospitals in Kenya’s eight provinces.

Source: http://www.nation.co.ke/Features/DN2/Kenya%20teetering%20on%20the%20edge%20of%20a%20colossal%20cancer%20disaster%20/-/957860/1072328/-/101gdu2z/-/index.html

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Now men can make babies without women

Posted by Administrator on December 14, 2010

File | NATION The new technology used by men to produce babies has already been used in livestock. Here Dr Henry Mutembei shows off IVF-Kapiti 1, a test-tube calf produced by the University of Nairobi and the International Livestock Research Institute last year.

File | NATION The new technology used by men to produce babies has already been used in livestock. Here Dr Henry Mutembei shows off IVF-Kapiti 1, a test-tube calf produced by the University of Nairobi and the International Livestock Research Institute last year.

Now men may be able to make babies without women, through a technology that could for the first time allow same sex couples to have their own genetic children.

In a technology developed to help in preserving endangered species and improving livestock breeds, scientists have, for the first time, developed an offspring from two males.

In a way, this renders null and void, the arguments by anti-gay activists that only opposite sexes lead to procreation. But not all will be lost to potential mothers as a female will be required to carry the pregnancy to term.

Using cell technology, scientists in the US say it is also possible to develop an offspring from one male, though this will need some time to refine.

A statement from the Society for the Study of Reproduction cites the report posted online last Wednesday in the Journal Biology of Reproduction says the development is a major step in advancing human assisted reproductive technology or test tube babies.

Currently same sex couples depend on adopting children or donated eggs from a female, but this could dramatically change the equation.

The researchers manipulated cells from male mice and produced cells that were implanted into a surrogate female mouse.

The surrogate gave birth to males and females and when these babies grew, they mated with normal mice.

“Their offspring, both male and female, showed genetic contributions from the two fathers,” says the statement.

The technology could be important for beef breeders as it could upgrade or retain high quality genetic strains without investing much in high maintenance females.

Last year the Nairobi based International Livestock Research Institute and the University of Nairobi succeeded in breeding Kenya’s first test-tube calf using a technique called In Vitro Embryo Production (Ivep).

When commercialised, farmers can rent their best cows as donors and their lower-quality cows as surrogates.

The Texas team may be hitting back for men. Last year British researchers discovered a way of making an artificial sperm, which may allow women to make babies without men.

The technology which the Newcastle University researchers said could be perfected by 2015 similarly used stem cells to attain the feat.

The researchers said the development will lead to new ways of assisting couples suffering from infertility so that they can have a child which is genetically theirs.

Kenya’s pioneering doctor in test tube baby technology, Dr Joshua Noreh was pessimistic that such technologies could become an every day solution to reproduction.

While this may offer an option, he had told the Nation, it could be difficult to guarantee that babies done from such technologies were 100 per cent healthy or that they will not develop complications later in life.

Source: http://www.nation.co.ke/News/Now%20men%20can%20make%20babies%20without%20women%20%20/-/1056/1072502/-/nnqof3z/-/index.html

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Prostitutes say clients refuse to use condoms and beat them up

Posted by Administrator on December 14, 2010

Concern over the failure by prostitutes to access Aids information and contraceptives is sending jitters in government and civil society.

With HIV prevalence among prostitutes standing at 14.1 per cent, twice than the national prevalence of 7.1 per cent, Ministry of Health officials are worried that failure to reach them will severely undermine prevention efforts.

Recent studies show that a higher number of prostitutes and their male clients are not using condoms, exposing themselves to HIV and other sexually transmitted infections.

One of the studies, which targeted sex workers in Kibera slums, and which is expected to be published early next year, had two startling findings: the failure by male clients to use condoms and the sexual violence female workers are subjected to.

According to the study conducted by Prof Elizabeth Ngugi, a lecturer at the University of Nairobi, of the 2,978 sexual acts the 161 prostitutes had with male clients in a month, condoms were not used in 900 acts.

This was disturbing because the prostitutes who were HIV positive confessed that in 177 sexual acts, they did not use a condom. On average, a prostitute has between two and three male partners in a day, sometimes engaging in several sexual acts with the same client.

Many of these men are either married, or have other female partners.

The study further found that of the 143 prostitutes who were tested for HIV, 27 per cent returned positive results. When the women were asked why they were not using condoms, they said sometimes their male clients threatened them with death if they insisted on safe sex.

For others, the male clients offered to pay a higher fee to have unprotected sex. The prostitutes said the risk of unprotected sex is high hence the need to charge a higher fee.

Others said they were raped or subjected to other forms of sexual violation like burning their genitals with cigarettes if they refuse to have unprotected sex.

Equally disturbing was the finding of an increasing number of young girls between 10 and 18 years entering the sex trade. These are the sex slaves, who are most vulnerable to HIV infection because they lack, among other things, negotiation skills when dealing with older men.

Another study conducted this year, and which involved mapping of prostitutes in Kenya, Uganda, and Tanzania, revealed the serious human rights violations facing prostitutes.

Supported by Open Society Foundation and HIVOs of the Netherlands, the mapping found how prostitutes are struggling to stave-off the violations they are subjected to daily.

To survive, they have formed networks through which they notify each other of violent male clients, police raids, bail out those arrested, and pay medical and burial expenses for colleagues who die as result of these violations.

The prostitutes point out police, clients, and the law as the main source and cause of the brutality they are experiencing.

It is this brutality and the discrimination by the society that is making it difficult for prostitutes to come out and share their tribulations.

Many are also unable to access information on family planning, condoms, maternal health service, and prevention of a range of sexually transmitted infections.

According to Ms Wanjiru Ngugi, the programmes coordinator at Life Bloom Service International, a group that rehabilitates and provides life skills to prostitutes, the reasons for this state of affairs is the intense stigmatising and abuse prostitutes are subjected to, and the failure by the law to legalise the trade. It is this stigma that makes their male clients violate them with abandon.

“The stigma makes it difficult for them to come out and seek reproductive health information and condoms even when they need them,” Ms Ngugi says.

The society also labels prostitutes as people of base character who are blamed for every social ill that afflicts humanity from high HIV prevalence to impoverishing men. Police harass them under the pretext that they are engaging in a criminal acts.

Such tagging has made prostitutes operate incognito, thus emerging as one of the most difficult groups to identify, provide reproductive health services for and protect their human rights.

Dr Ibrahim Mohammed, the director of National Aids and STD Control Council says “because of the way they are labelled, prostitutes and their clients sometimes live reckless lives.

“While much has been done in helping them access HIV prevention, management and other reproductive health services, they remain prone to unsafe sex.”

Ms Mary Achieng’, who has been in sex business for eight years, confirms: “Many of us feel the society does not love us, and hence do not care whether we infect people or harm them.”

“If you love and appreciate our human rights, then we are likely to have self-esteem and listen to what the society is saying,” adds the 34-year-old mother of two.

Health analysts argue that because of the stigma by the society and brutality by police and male clients, prostitutes are one of the groups that is both vulnerable to infections and one of the key drivers of the disease.

Source: http://www.nation.co.ke/News/Prostitutes%20say%20clients%20refuse%20to%20use%20condoms%20and%20beat%20them%20up%20%20/-/1056/1072504/-/lato4a/-/index.html

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Ocampo to name Kenyan suspects at 2pm

Posted by Administrator on December 14, 2010

Luis Moreno Ocampo to announce suspects at 2pm Kenyan time on Wednesday.

Luis Moreno Ocampo to announce suspects at 2pm Kenyan time on Wednesday.

The much awaited announcement by International Criminal Court (ICC) Luis Moreno-Ocampo of names of six post election violence suspects will be made at 2pm local time on Wednesday.

A statement from ICC said that the press conference where he is expected to make public the names of the six Kenyans behind the 2008 chaos will not be held at 5pm as earlier announced.

Ocampo will present two cases, both with up to three suspects, and is widely expected to name suspects from Kenya’s two main political movements: the Party of National Unity and the Orange Democratic Movement.

Web streaming of the press conference will be available at the following links:

The naming of the suspects is already heightening tensions in the country but the government has assured Kenyans of security during the ICC process. 

ICC Chief Prosecutor Luis Moreno-Ocampo started a formal probe in March 2010 into the 2008 post-election violence in which 1,220 people died and more than 350,000 were displaced.

Coalition leaders, business leaders and security chiefs could be named, and although the prosecutor has said he will request summons for voluntary appearances, judges could still opt to issue arrest warrants

“The best-case scenario would be to have ICC prosecutions going forward and complemented at the national level with additional trials of other perpetrators,” said Liz Evenson at Human Rights Watch.

“At the end of the day, it is up to ICC judges to decide whether there is some national proceeding in place that cuts off ICC jurisdiction, but I think we’re still far off from that.”.

Kenya said on Monday it would set up a local court to try suspects involved in the violence and that it would be established regardless of what the ICC does.

Source: KBC

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