3rd February 2004
As if SARS I wasn't enough last year we now have SARS II plus avian 'flu. There's no doubt about it, globalisation means that everything is very near. Everything is our business.
The World Bank had nearly as bad a reputation as the International Monetary Fund for the last twenty years in that Third World countries were encouraged to take on huge loans which they then had great trouble in repaying. This was the mother of the child called "Debt Forgiveness". A few years ago I joined an eclectic group of parliamentarians who go to different countries seeing how the World Bank is behaving there and how their projects are going. The World Bank is cultivating a better image, focusing on Poverty Reduction (which is gender proofed so that it is politically correct) and HIV/AIDS reduction. We also collaborate with parliamentarians in the host country.
This year we went to Ethiopia, sponsored by the Finnish Government. This was my third visit to Ethiopia and when I wrote about that country before I was delighted to receive letters from several readers of the Irish Medical News who had visited and worked there, too. It is one of the poorest countries in Africa, is one of Development Co-operation Ireland's six priority countries in Africa and is inhabited by truly delightful people with a great history and culture but with many, many problems which need urgent attention.
Firstly there is HIV/AIDS. Ethiopia got off to a very poor start with treating this infection. When it emerged in Africa the Derg were in government having overthrown Haile Selassie in 1974 in a bloody coup. The Derg were not very interested in preventative medicine and infection control. By the time they in turn were overthrown in 1991, HIV/AIDS had had a good start in the population.
The World Bank is putting huge (like 100 million dollars) into the HIV/AIDS Prevention Control office in Addis Ababa but much of this money is not being spent because of bureaucratic difficulties. Now I do realize that it is very difficult to get information out to a country with countless languages and dialects (countless because everyone gives me different counts) but the Human Immunosuppressant Virus is not going to wait for everyone to have second level education so that all can be explained to them properly about this virus. At local level, initiatives have to be supported and the Bank is trying to be more relaxed about applications which are obviously worthwhile.
Our group of parliamentarians was diverse, some being from Uganda, Tanzania, Kenya, Gabon and Gambia. These parliamentarians were far more able than I or those from France, Belgium, and the Netherlands to give guidance to their fellow Africans. More openness was urged about addressing the dreadful stigma attached to HIV in Ethiopia. They all promised to help their fellow parliamentarians with advice and encouragement. The Ugandan parliamentarians attributed their own success in reducing HIV infection to their open attitude to the issue.
I went to visit some AIDS patients in their homes. They were being cared for by volunteers from a charity called MENDIK. Many had been deserted by their own families. I do not know the religion, if any, of the volunteers but it was charity at its finest that I saw. How I wished they had help from the hospice movement in other parts of East Africa set up by Dr. Anne Merriman who can give morphine and other drugs to those in extreme pain. The Ethiopian Government will not allow the import of morphine at present for a hospice type unit to be developed fearing drug abuse. Some of the patients I saw were very ill, wrapped in layers and layers of clothes and blankets even though it was 30C outside their pathetic houses. Most were young women, late twenties to mid thirties and I would say some have died since I left. They were short of food and had no retroviral drugs, of course.
President George W. Bush has made many caveats about the U.S. contribution to the Global Fund for HIV/AIDS. One is that abstinence from sexual activity must be promoted. Of course he is right, and our colleague from the Philippines did say she felt that the promotion of monogomy by the Roman Catholic Church in that country to be important in the low rate of HIV there. But as one of the Kenyans pointed out polygamy was legal until recently in most African countries and still the practice in places where it is illegal.
It is all very well making pronouncements in Washington and elsewhere about how people should behave but it can be more difficult in practice than one would think to enforce an idea. I have spoken out for years about the protection of children from sexual abuse by adults. Here people are now prosecuted but in Ethiopia the abduction of children is common and often nothing is done about the abduction. The situation is so bad in some rural areas that girls are not sent to school.
There was great rejoicing while I was in Addis Ababa when the abductor of a thirteen year old girl was apprehended and arrested. It takes a big effort to get children's rights recognised and we should remember they were ignored for too long here and not be too critical.
More on Ethiopia to follow.
Senator Mary Henry, MD
