Dark Clouds
My search for clues as to how the 20-year conflict in northern Uganda will end, has drawn me back again and again to the IDP camps and the countless children they contain. I have no doubt there will be an end to the LRA and it will be soon. I also think there will be a second and even more chaotic and probably bloody phase as people return to their lands and disputes over ownership lead to community conflict. But that too will eventually be resolved. A far darker and impenetrable cloud looms, not just over the north but the whole of Uganda; one that threatens Uganda’s stated goal, to emerge as a middle-income economy by 2025 and perhaps the very future of the nation: a population growing at a speed that almost beggars the imagination.
It seems counter-intuitive that a country ravaged by war and disease, particularly HIV/AIDS, on the scale that Uganda has suffered for 25 years, would be undergoing a population explosion. It is even less conceivable when viewed against a background of an infant mortality rate of over 70 per 1,000, a maternal mortality rate of almost 500 per 100,000 live births and a life expectancy at birth of around 50 years. But the population is increasing at a rate that should set alarm bells ringing in Kampala - it has doubled in the past 20 years - yet the subject doesn’t figure on the political agenda, academic debate or social discussion. It is the Elephant in the Sitting Room everyone is trying to ignore.
Lampposts
The facts are carefully and unemotionally laid out in a document, Uganda: Population, Reproductive Health and Development: 2005, by the Ugandan Ministry of Finance, Planning and Economic Development. It is a little-known publication, which Google failed to identify in the welter of online articles on youth, gender, HIV and other socio/economic subjects concerning Uganda. I am well aware of the saw, “Statistics is like a lamppost to a drunk. It's there more for support than illumination” but I offer some numbers from the book to underpin my argument.
The Fertility Rate in Uganda (numbers of babies each woman produces in her lifetime) is currently somewhere between 7 and 8, little changed over 30 years. The Replacement Rate (numbers of babies required to sustain a stable population) used in demographic science, is 2.1. All countries in the developed and many in the developing world are close to or below that rate. Neighboring Kenya is about 4 and falling. Nigeria, often cited as a country with a looming population problem is 5.5. The Ugandan population is currently estimated at 29m, if the Fertility Rate continues unchecked the population will double to 60m by 2025. If it halves to 3, the figure will still be a huge 45m by this date. I have found no evidence of a drop in the rate.
Young in a Slum
There is a school of thought that argues population growth on this scale is not all bad and that Africa has traditionally suffered from too small a population to grow a strong internal market. This may be so, but a combination of high birth rates and the ravages of HIV have skewed Uganda’s population. Over 55% of the population is under 16 years, the average age of Uganda is 14 years and a few months. This has short and long-term implications: the child dependency ratio (numbers of child dependents to adults) is 100:100 placing huge strain on working adults and social services, particularly schools and health services. In the long term these children will enter the workplace which currently cannot provide modern-economy jobs for even a fraction of its workforce, estimated as an annual need of 200k. At current predictions there will be a requirement for between 0.5m and 0.75m new jobs a year by 2025, an impossible goal to achieve.
As if this isn’t daunting enough, there is another distortion to the equation, urbanization. The population of the capital, Kampala was 450k in 1980, today its about 1.5m, small by African city standards, but it’s an overcrowded city with over 50% of the population in temporary housing (euphemism for slums). If the present rate of urbanization of 7% continues unchanged (the trend throughout Africa is upwards) at the current rate of population growth, Kampala will be a huge 3.5m by 2025 (and double its current size to 2.8m if this rate halves). Nationwide, the estimated increase in urbanization - to 18.5m by 2025 - will require another 12 “new Kampalas” to be built in less than two decades. Population growth halved will still need 9 “new Kampalas”. It is hard to imagine how the country could develop housing, infrastructure and power for 9 or more new cities in less than 20 years
Contraception and Culture
During my investigations, I discovered amongst all the troubling predictions, a startling fact: in Uganda, research shows 35% of married women currently want to space or limit their births but are not using contraceptives. There is no data on unmarried women who do not want to get pregnant but don’t use contraception but it would be a fair guess that the figure is even higher. The UNFPA estimates the overall ‘contraceptive prevalence’ as less than 20%. Why this unmet need exists is difficult to discern but appears to be a mixture of government complacency - it has not identified high population growth as a critical threat to development, traditional culture – family planning has never been a cultural practice, and the attitudes and moral teaching of religious organizations and faith-based groups, which fundamentally disapprove of contraception or believe that freely available contraceptives - particularly condoms for the unmarried - promotes promiscuity, with increased risk of unwanted pregnancies and HIV.
More recently the Government, led by the President and First Lady, have been overtly manipulating the long-standing A(bstinence) B(e faithful) C(ondoms) approach to HIV prevention by placing greater influence on AB and less on condom use. The result has included a nation-wide shortage of condoms, which must have impacted upon their availability for contraceptive use.
Marketplace Morality
There has been much talk about the undue influence of the US in this domestic turmoil, particularly condom availability. Matters came to a head when the UN Secretary General’s Special Envoy for HIV/AIDS in Africa, Stephen Lewis, told a world-wide teleconference on AIDS, Uganda’s policy shift has been influenced by the US government “which is now mainly promoting pro-abstinence programmes and less of condom use”. Dr. Mark Dybul, the US global AIDS co-coordinator, rebutted the charge, stating there was no change in US policy, current emphasis on abstinence is only to ensure a more balanced ABC strategy.
Research suggests Dr Dybul is being economical with the truth. USAID policy and procurement regulations for contraceptives, including condoms for HIV prevention, for foreign aid projects can be found at ADS 312.5.3d of the organization’s procurement manual. The key words amongst all the jargon are: “Source/Origin and Nationality - Contraceptive products shall meet the requirements for U.S. source, origin and nationality”. In other words recipients of US funding for both reproductive health and HIV prevention programs must buy American. Maybe the US government indeed has no hidden moral agenda for shaping Ugandan reproductive health policy, unless you count the morality of the marketplace. But the effect of such blatant trade protectionism can only be to limit availability of reproductive health resources to Uganda and elsewhere, by denying access to cheaper, equally high-standard generic contraceptives on the global market.
Rearranging the Deckchairs
Whereas Uganda, as a sovereign state, does not welcome overt outside interference in domestic policies, the very disturbing scenario I have described for Uganda’s population and development must surely impact upon national and, in turn, regional security. Given that the USA, as one of Uganda’s largest aid donors, has much influence on national issues, it seems sensible foreign policy for the US government to offer guidance and resources to help Uganda limit the worst effects of its rapid population growth. To do otherwise is to do no more than help the Ugandans rearrange the deckchairs on their personal Titanic.
Showing posts with label Roll Back Malaria Uganda ITNs DDT. Show all posts
Showing posts with label Roll Back Malaria Uganda ITNs DDT. Show all posts
Monday, April 9, 2007
Friday, February 23, 2007
Occam's Razor and the Silver Bullet Gambit
Entia non sunt multiplicanda praeter necessitatem (Entities should not be multiplied beyond necessity.) - William of Ockham, 14th C philosopher
It began in the early New Year when I traveled to England on family business. Within 48 hours of landing in cold, crowded Heathrow I had a nasty Upper Respiratory Tract Infection (URTI). Notwithstanding my brother and I discovering our recently deceased father’s stash of old and distinguished whiskies, and consuming a plentiful amount in his memory, I felt increasingly miserable and the cough got worse.
After ten days in wintry England I began my two day journey back to northern Uganda, feeling very sorry for myself, convinced my URTI was morphing into pneumonia and regretting not seeing a doctor before leaving. The first night back in Lira I spiked a temperature of 101F and alternately sweated and shivered the night away, resolving to find a doctor, have a chest x-ray, whatever other diagnostic procedure was available and start industrial strength antibiotics post haste. The following day I felt better and convinced myself my ‘chest-cold’ had been exacerbated by the long journey and the abrupt change in climate. That night I spiked another fever and all the alarm bells rang…well, at least with my wife who insisted I get a test for malaria in the morning.
At 8am we were in a small mission clinic in town, sat amongst a group of fifty or so patients, mainly women with babies or pregnant or both; the nurse told me, most probably had malaria. Eventually I took my turn to be stabbed in the finger by a young laboratory technician called Fred, who explained what he was doing and how he would reach a diagnosis. Half an hour later he emerged from the lab to announce “ Mzee (respectful title for elder male) you are a strong man, you have over 50 parasites to 100 WBC!”
My immediate reaction was in character, I was overwhelmed with self-pity. Malaria? Why me? How? I am so careful and have never had it before in my life. Etc etc. The next 36 hours is a bit of a fog. I know well enough the standard treatment protocol and always have a stock of Co-ArtemÒ (a combination of artemether and lumefantrine) in the fridge. I have used it on patients in the middle of no-where and it works like magic. Given that I had a weapons-grade dose of the disease, I embarked on a ‘take-no-prisoners’ counter-attack: a full course of 20/120 Co-ArtemÒ plus 100mgs of Doxycycline twice daily as insurance, analgesics and gallons of water. My wife nursed me diligently. My temperature see-sawed around 101F to 105F, I crawled to the shower, ached in places I did not know I could and was visited by very strange creatures which walked the bedroom walls . After 72 hours, I emerged from my bed an old man. It took a further week to nurture my appetite and get out and about.
“If you hear hoof beats behind you, look for horses not zebras” - Dr Jay Sanders, an old friend and mentor.
My purpose in recounting this story is not self-indulgence. It raises some very clear issues for me. The first is how easily I reached a [wrong] conclusion as to what ailed me. In my defense, I had strong circumstantial and symptomatic evidence to support my ‘diagnosis’. Though I don’t take prophylactic antimalarial medicine – it’s neither feasible nor affordable over years – I do take every other precaution, covering up in the evening, use insect repellents and always sleep under an Insecticide Treated Net (ITN). I am rarely bitten and have never before had malaria.
My initial symptoms where of an URTI and I contracted that in the UK. The cough and chest pain became the focus of my illness. It was 13 days from the time I left Uganda and 2 days after I returned before I suffered my first classic malaria rigor and by that time I had a very high level of parasites in my blood. The malaria is long gone but I still have a hacking cough. I had followed the age-old saw of medicine drawn from Occam’s premise, to suspect the obvious and commonplace – horses not zebras. I made two errors, I was living in a part of Africa where there are no horses only zebras and I had ignored another famous medical saw, Hickam’s Dictum, “a patient can have as many diseases as he damn well pleases.” I had both an URTI and malaria, a disease from each continent and one masking the other. It’s not a mistake I will make readily again.
No-one who lives in Africa can ignore malaria, and I have written about it on a number of occasions; now I have first-hand knowledge of the illness. It is not something I wish to repeat. But I was lucky, I had the education and resources to protect me and to be diagnosed and treated when prevention failed. For most of my neighbors in Lira and Uganda in general, there is scant help and many die. About 400 Ugandans die every day from malaria, mostly children under five and pregnant mothers. The data for other countries in sub-Saharan Africa are similar. Despite the efforts of international organizations, governments and non-government organizations (NGOs) nothing seems to be making a dent in the death toll, to the contrary, it is inexorably rising.
In 1998 the UN, WHO, a host of governments and NGOs launched a program, Roll Back Malaria (RBM), aimed at halving deaths from malaria by 2010 – almost 90% of these deaths are in sub-Saharan Africa. With less than three years to go the annual number of deaths worldwide from malaria is higher now than in 1998, rising from 5.5m in 1998 to a staggering 16m in 2004. If ever there was a failure of an international initiative, one that has been trumpeted around the world in every manner of global forum, and funded to the tune of hundreds of millions of dollars, the Roll Back Malaria is the classic example. It is a damp squib. Why? If Uganda is any example, the impending demise of RBM is a result of broken promises, ineptitude, misplaced reliance on ‘silver-bullet’ solutions and the defeat of science by soap opera. In theory Uganda has the three tools needed to curb malaria deaths—effective combination treatment based on artemisinin, ITNs and insecticides. A glance at each might throw some light on why Uganda is losing the fight.
The reality is that most Ugandans consider malaria like Americans view a common cold, hardly something you visit a physician for unless it gets really bad. The parallels between the US and Uganda in this regard are striking. Americans, with colds, rather than navigate the complexities and costs of a physician consult, will self-medicate or at most, seek the advice of a pharmacist. Ugandans do the latter. But they rarely have access to trained pharmacists and they have to pay out of pocket. They opt for the cheapest plan. This can be anything from traditional herbal medicine through dangerously ineffective but cheap combination therapies like chloroquine and fansidar, to effective but hugely painful intra-muscular quinine. Combination treatments based on artemisinin, that rescued me from who-knows-what, are being made available through the WHO and Global Fund but given the ineptitude of the Ugandan healthcare system, are only slowly permeating down to the ‘village’. As in all matters Ugandan though, there is always a way for those who can pay.
Talk to any member of the malaria prevention cognoscenti and they will wax lyrical about the ITN and its life saving properties. It is the ‘killer app’, the ‘silver bullet’ of modern malaria intervention, single-handedly able to reduce malaria deaths by over 60%. Despite what Sharon Stone and other glitterati would have us believe, ITNs have been around a long time and yet have not made a significant impact on malaria. Why? The ITN lobby insists it is a problem of supply, not enough are available. But there are more complex issues that the ‘silver bullet’ theorists downplay. ITNs cost more to distribute than to make and distribution is complex business, fraught with issues of local politics and economics. Then there are some banal practical facts: you cannot live 24/7 under an ITN, mosquitoes bite most in early evening and morning, when ordinary folks are up and about. They are hot to sleep under, particularly when there are eight people living in a small hut, and they are a fire hazard in huts where the only means of illumination is a candle or paraffin lamp. This is not a dismissal of ITNs, I swear by mine; rather a recognition that ITNs alone cannot beat malaria.
The third leg of the triad, vector control with insecticides, is the most contentious, mainly because it involves a dirty word, Dicophane or DDT. This is not the time or place for a history lesson on DDT, most readers are well aware of Silent Spring and the American experience with agricultural use of DDT. I have also expressed my bias in previous articles. For anyone who wants a serious scientific opinion on the issue, I recommend, “Balancing Risks on the Backs of the Poor” by Amir Attaran et al Nature.
The plain fact is that in terms of cost and effectiveness, DDT has no rival as an insecticide in vector control of insect-borne disease. Despite libraries of research, much conducted during and immediately after the time when DDT was used on a huge scale in the USA and elsewhere, there is no science to support the claim that DDT harms human health. Moreover, the strategy for DDT use in vector control, is to spray, small amounts of oil-based liquid inside selected homes and buildings once or twice a year in a tactic called Indoor Residual Spraying (IRS). To put this in perspective, back in the old days, US farmers would spray 1,100kgs of DDT on 100 hectares of cotton in four weeks. IRS would use this much to spray every building in northern Uganda in a year. It is not surprising therefore that the Stockholm Convention on Persistent Organic Pollutants (POPs) in 2004, exempted DDT for use in control of insect borne disease. Nor that in September 2006 the WHO announced their support for IRS using DDT in malaria control.
When, shortly after the WHO announcement, Uganda announced it would embark on IRS using DDT as the third leg of its RBM initiative, the reaction and rhetoric from activists, local and international, resembled a soap opera. Every well-worn cliché and threat was rolled out, ranging from the disastrous impact on agricultural exports to ‘recent studies that showed massive IQ loss in children whose mothers were exposed to DDT’. Even if tiny amounts of DDT from IRS, leached into agriculture it’s a stretch to see how this would destroy the nations principal exports, cut-flowers, tea and coffee. My favorite warning of agricultural Armageddon resulting from DDT use in Uganda came from the British American Tobacco company, delivered without a hint of irony!
As to IQ loss in children, I have not researched the study quoted, but I doubt that the damage, if any, could match the destruction of children’s brains inflicted by malaria every year here. As a small measure, my wife plans to fund a project for care of epilepsy patients ( there seems to be a correlation between infantile malaria and epilepsy) in Lira; there are an estimated 1,000 plus – in a population of less than100,000. No rational argument seems to sway the activists in Physicians for Social Responsibility (PSR) or the Pesticide Action Network (PAN), maybe because it threatens their funding and their salaries. But every day they succeed in delaying the implementation of IRS, they need to explain why hundreds of Ugandans must continue to die.
What Uganda needs is a coherent, well resourced and managed plan to ‘Roll Back Malaria’; by every measure, the current plan is not working and I am a recent victim. The Plan must include all three legs of the triad, effective treatment, nation-wide distribution and use of ITNs and IRS, using the best insecticide currently available, DDT. Over-reliance on ITNs will fail. As to the siren calls of PSR and PAN so concerned about our future but with no solutions for today, I have only one comment. Close down your expensive offices in malaria-free San Francisco, Washington DC and Nairobi and open them in Lira. Bring your families, leave behind your expensive malaria prophylaxis and designer insect repellants. Come and sleep under an ITN and work here for a couple of years. Then you will have a credible voice at the table.
It began in the early New Year when I traveled to England on family business. Within 48 hours of landing in cold, crowded Heathrow I had a nasty Upper Respiratory Tract Infection (URTI). Notwithstanding my brother and I discovering our recently deceased father’s stash of old and distinguished whiskies, and consuming a plentiful amount in his memory, I felt increasingly miserable and the cough got worse.
After ten days in wintry England I began my two day journey back to northern Uganda, feeling very sorry for myself, convinced my URTI was morphing into pneumonia and regretting not seeing a doctor before leaving. The first night back in Lira I spiked a temperature of 101F and alternately sweated and shivered the night away, resolving to find a doctor, have a chest x-ray, whatever other diagnostic procedure was available and start industrial strength antibiotics post haste. The following day I felt better and convinced myself my ‘chest-cold’ had been exacerbated by the long journey and the abrupt change in climate. That night I spiked another fever and all the alarm bells rang…well, at least with my wife who insisted I get a test for malaria in the morning.
At 8am we were in a small mission clinic in town, sat amongst a group of fifty or so patients, mainly women with babies or pregnant or both; the nurse told me, most probably had malaria. Eventually I took my turn to be stabbed in the finger by a young laboratory technician called Fred, who explained what he was doing and how he would reach a diagnosis. Half an hour later he emerged from the lab to announce “ Mzee (respectful title for elder male) you are a strong man, you have over 50 parasites to 100 WBC!”
My immediate reaction was in character, I was overwhelmed with self-pity. Malaria? Why me? How? I am so careful and have never had it before in my life. Etc etc. The next 36 hours is a bit of a fog. I know well enough the standard treatment protocol and always have a stock of Co-ArtemÒ (a combination of artemether and lumefantrine) in the fridge. I have used it on patients in the middle of no-where and it works like magic. Given that I had a weapons-grade dose of the disease, I embarked on a ‘take-no-prisoners’ counter-attack: a full course of 20/120 Co-ArtemÒ plus 100mgs of Doxycycline twice daily as insurance, analgesics and gallons of water. My wife nursed me diligently. My temperature see-sawed around 101F to 105F, I crawled to the shower, ached in places I did not know I could and was visited by very strange creatures which walked the bedroom walls . After 72 hours, I emerged from my bed an old man. It took a further week to nurture my appetite and get out and about.
“If you hear hoof beats behind you, look for horses not zebras” - Dr Jay Sanders, an old friend and mentor.
My purpose in recounting this story is not self-indulgence. It raises some very clear issues for me. The first is how easily I reached a [wrong] conclusion as to what ailed me. In my defense, I had strong circumstantial and symptomatic evidence to support my ‘diagnosis’. Though I don’t take prophylactic antimalarial medicine – it’s neither feasible nor affordable over years – I do take every other precaution, covering up in the evening, use insect repellents and always sleep under an Insecticide Treated Net (ITN). I am rarely bitten and have never before had malaria.
My initial symptoms where of an URTI and I contracted that in the UK. The cough and chest pain became the focus of my illness. It was 13 days from the time I left Uganda and 2 days after I returned before I suffered my first classic malaria rigor and by that time I had a very high level of parasites in my blood. The malaria is long gone but I still have a hacking cough. I had followed the age-old saw of medicine drawn from Occam’s premise, to suspect the obvious and commonplace – horses not zebras. I made two errors, I was living in a part of Africa where there are no horses only zebras and I had ignored another famous medical saw, Hickam’s Dictum, “a patient can have as many diseases as he damn well pleases.” I had both an URTI and malaria, a disease from each continent and one masking the other. It’s not a mistake I will make readily again.
No-one who lives in Africa can ignore malaria, and I have written about it on a number of occasions; now I have first-hand knowledge of the illness. It is not something I wish to repeat. But I was lucky, I had the education and resources to protect me and to be diagnosed and treated when prevention failed. For most of my neighbors in Lira and Uganda in general, there is scant help and many die. About 400 Ugandans die every day from malaria, mostly children under five and pregnant mothers. The data for other countries in sub-Saharan Africa are similar. Despite the efforts of international organizations, governments and non-government organizations (NGOs) nothing seems to be making a dent in the death toll, to the contrary, it is inexorably rising.
In 1998 the UN, WHO, a host of governments and NGOs launched a program, Roll Back Malaria (RBM), aimed at halving deaths from malaria by 2010 – almost 90% of these deaths are in sub-Saharan Africa. With less than three years to go the annual number of deaths worldwide from malaria is higher now than in 1998, rising from 5.5m in 1998 to a staggering 16m in 2004. If ever there was a failure of an international initiative, one that has been trumpeted around the world in every manner of global forum, and funded to the tune of hundreds of millions of dollars, the Roll Back Malaria is the classic example. It is a damp squib. Why? If Uganda is any example, the impending demise of RBM is a result of broken promises, ineptitude, misplaced reliance on ‘silver-bullet’ solutions and the defeat of science by soap opera. In theory Uganda has the three tools needed to curb malaria deaths—effective combination treatment based on artemisinin, ITNs and insecticides. A glance at each might throw some light on why Uganda is losing the fight.
The reality is that most Ugandans consider malaria like Americans view a common cold, hardly something you visit a physician for unless it gets really bad. The parallels between the US and Uganda in this regard are striking. Americans, with colds, rather than navigate the complexities and costs of a physician consult, will self-medicate or at most, seek the advice of a pharmacist. Ugandans do the latter. But they rarely have access to trained pharmacists and they have to pay out of pocket. They opt for the cheapest plan. This can be anything from traditional herbal medicine through dangerously ineffective but cheap combination therapies like chloroquine and fansidar, to effective but hugely painful intra-muscular quinine. Combination treatments based on artemisinin, that rescued me from who-knows-what, are being made available through the WHO and Global Fund but given the ineptitude of the Ugandan healthcare system, are only slowly permeating down to the ‘village’. As in all matters Ugandan though, there is always a way for those who can pay.
Talk to any member of the malaria prevention cognoscenti and they will wax lyrical about the ITN and its life saving properties. It is the ‘killer app’, the ‘silver bullet’ of modern malaria intervention, single-handedly able to reduce malaria deaths by over 60%. Despite what Sharon Stone and other glitterati would have us believe, ITNs have been around a long time and yet have not made a significant impact on malaria. Why? The ITN lobby insists it is a problem of supply, not enough are available. But there are more complex issues that the ‘silver bullet’ theorists downplay. ITNs cost more to distribute than to make and distribution is complex business, fraught with issues of local politics and economics. Then there are some banal practical facts: you cannot live 24/7 under an ITN, mosquitoes bite most in early evening and morning, when ordinary folks are up and about. They are hot to sleep under, particularly when there are eight people living in a small hut, and they are a fire hazard in huts where the only means of illumination is a candle or paraffin lamp. This is not a dismissal of ITNs, I swear by mine; rather a recognition that ITNs alone cannot beat malaria.
The third leg of the triad, vector control with insecticides, is the most contentious, mainly because it involves a dirty word, Dicophane or DDT. This is not the time or place for a history lesson on DDT, most readers are well aware of Silent Spring and the American experience with agricultural use of DDT. I have also expressed my bias in previous articles. For anyone who wants a serious scientific opinion on the issue, I recommend, “Balancing Risks on the Backs of the Poor” by Amir Attaran et al Nature.
The plain fact is that in terms of cost and effectiveness, DDT has no rival as an insecticide in vector control of insect-borne disease. Despite libraries of research, much conducted during and immediately after the time when DDT was used on a huge scale in the USA and elsewhere, there is no science to support the claim that DDT harms human health. Moreover, the strategy for DDT use in vector control, is to spray, small amounts of oil-based liquid inside selected homes and buildings once or twice a year in a tactic called Indoor Residual Spraying (IRS). To put this in perspective, back in the old days, US farmers would spray 1,100kgs of DDT on 100 hectares of cotton in four weeks. IRS would use this much to spray every building in northern Uganda in a year. It is not surprising therefore that the Stockholm Convention on Persistent Organic Pollutants (POPs) in 2004, exempted DDT for use in control of insect borne disease. Nor that in September 2006 the WHO announced their support for IRS using DDT in malaria control.
When, shortly after the WHO announcement, Uganda announced it would embark on IRS using DDT as the third leg of its RBM initiative, the reaction and rhetoric from activists, local and international, resembled a soap opera. Every well-worn cliché and threat was rolled out, ranging from the disastrous impact on agricultural exports to ‘recent studies that showed massive IQ loss in children whose mothers were exposed to DDT’. Even if tiny amounts of DDT from IRS, leached into agriculture it’s a stretch to see how this would destroy the nations principal exports, cut-flowers, tea and coffee. My favorite warning of agricultural Armageddon resulting from DDT use in Uganda came from the British American Tobacco company, delivered without a hint of irony!
As to IQ loss in children, I have not researched the study quoted, but I doubt that the damage, if any, could match the destruction of children’s brains inflicted by malaria every year here. As a small measure, my wife plans to fund a project for care of epilepsy patients ( there seems to be a correlation between infantile malaria and epilepsy) in Lira; there are an estimated 1,000 plus – in a population of less than100,000. No rational argument seems to sway the activists in Physicians for Social Responsibility (PSR) or the Pesticide Action Network (PAN), maybe because it threatens their funding and their salaries. But every day they succeed in delaying the implementation of IRS, they need to explain why hundreds of Ugandans must continue to die.
What Uganda needs is a coherent, well resourced and managed plan to ‘Roll Back Malaria’; by every measure, the current plan is not working and I am a recent victim. The Plan must include all three legs of the triad, effective treatment, nation-wide distribution and use of ITNs and IRS, using the best insecticide currently available, DDT. Over-reliance on ITNs will fail. As to the siren calls of PSR and PAN so concerned about our future but with no solutions for today, I have only one comment. Close down your expensive offices in malaria-free San Francisco, Washington DC and Nairobi and open them in Lira. Bring your families, leave behind your expensive malaria prophylaxis and designer insect repellants. Come and sleep under an ITN and work here for a couple of years. Then you will have a credible voice at the table.
Subscribe to:
Posts (Atom)
