Your daily Selection of IRIN Africa PlusNews reports, 12/11/2006

December 11, 2006

U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network (IRIN) -

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - DRC: An untapped supply of HIV/AIDS treatment

2 - SWAZILAND: Nurses fleeing the HIV/AIDS frontline

1 - DRC: An untapped supply of HIV/AIDS treatment

KINSHASA, 11 December (PLUSNEWS) - Thousands of people living with AIDS in the

Democratic Republic of Congo (DRC) are going without treatment while the

production line at a modern antiretroviral (ARV) factory in the east of the

country lies largely idle.

Pharmakina has produced generic ARVs since April 2005 in the eastern province of

Bukavu, the first pharmaceutical firm to do so in central Africa, but it is now

forced to await approval from the World Health Organization (WHO).

" We can produce to a capacity of 180,000 pills a month [but] apart from [a few]

private individuals there is no real demand at present, " said Dr Pierre Mulema,

head of Pharmakina's HIV/AIDS department.

The only other suppliers of ARVs in Bukavu is Médecins Sans Frontieres (MSF),

which provides free treatment to more than 600 patients but currently imports

its supplies from Holland.

Pharmakina's generic version of a three-in-one drug combination of Stavudine,

Lamivudine and Nevirapine, is called 'Afri-Vir'. The Congolese authorities gave

the medication the go-ahead in June 2005, allowing Pharmakina to supply the

local market.

Dr Andre Adanji, WHO's humanitarian action in crisis focal officer in Bukavu,

confirmed the international agency was running tests on Pharmakina's product.

" We've already received samples and these have been sent to Geneva for testing, "

he said, adding that in principle, WHO supported the production of ARVs by

Pharmakina, but needed assurances on quality before allowing the product to be

exported out of the DRC.

" We have the capacity to produce ARVs to meet the demands of all in the DRC and

still export to neighbouring countries, " insisted Mulema. " There is a real need

in the DRC for good quality ARVs. " But with a price tag of US $22 per month, the

majority of HIV-positive people in South Kivu cannot afford Pharmakina's ARVs.

South Kivu's health system has been destroyed by more than 10 years of conflict.

Rebel groups from neighbouring countries and armed Congolese militia

systematically plundered villages and ransacked health centres.

While AIDS awareness levels are improving among the rural population as

education campaigns take effect, HIV testing and treatment facilities remain

severely limited as trained staff leave the region and the local health

authority struggles to replenish supplies.

" We have a serious problem with the provision of ARVs. It's true to say that

there are many in need of ARVs who are not receiving the drugs, " said Médard

Mpinda, acting co-ordinator of the National Multi-Sector Programme For the Fight

Against AIDS, the national body responsible for coordinating the country's

HIV/AIDS strategy.

Adanji said, however, that realistically, it is much too early for the DRC to be

talking of nationwide coverage. " I nearly choked to death with laughter when I

recently heard a government communiqué talking of the desire to make ARVs freely

available across the whole country. "

Pharmakina is urging the government and leading NGOs to get behind the concept

of local production and resolve the difficulties of acquiring ARVs. MSF Holland,

which currently imports ARVs from Amsterdam, says it was considering procuring

drugs from Pharmakina.

" By producing locally we stand the chance of saving thousands of lives simply by

saving time and cutting costs, " said Mulema. " What really hurts is that we have

the ARVs available, that are of a good quality, and there are patients who need

ARVs who can't access them. "

[ENDS]

2 - SWAZILAND: Nurses fleeing the HIV/AIDS frontline

MANZINI, 11 December (PLUSNEWS) - " Swaziland is dying. Will the last nurse on

duty please turn off the lights? " reads a handwritten note at a clinic in

Manzini, the country's AIDS-hit commercial centre, 35km southeast of the

capital, Mbabane.

The wry note disguises the pain of Swaziland's diminishing number of nurses and

hints at the reason why their colleagues have fled the country to offer their

services elsewhere.

" The working conditions, the lack of basic necessities to treat people and all

the dying: it is demoralising, " said a nurse, 28, who asked that her name not be

used. " It's not just the money - it is hard to watch people die and you are

helpless to do anything about it because there are no drugs or other things [to

treat them]. "

Working in a poorly lit, aging ward, with scant equipment and a chronic shortage

of drugs after the government failed to award tenders this year, are as much a

motivation to leave the country as any promise of greater financial reward in

Europe, the United States or neighbouring South Africa.

In the emergency room of Manzini's Raleigh Fitkin Memorial Hospital, a child

screams in pain as a nurse removes sutures from a stitched finger wound. " I

haven't got the proper cutter -they have such scissors in the paediatric ward, "

said the nurse as she gouged the tender skin around the wound with large

scissors not intended for this procedure.

In a recent report, 'Public sector nurses in Swaziland: can the downturn be

reversed?' released by Human Resources for Health, an online medical journal

published in collaboration with the World Health Organization, authors Katharina

Kober and Wim Van Damme noted, " The public health sector in Swaziland faces a

serious shortage of health workers: 44 percent of posts for physicians, 19

percent of posts for nurses and 17 percent of nursing assistant posts are

unfilled. We identified emigration and attrition due to HIV/AIDS as major

factors depleting the health workforce. "

UNAIDS estimates the national HIV infection rate of people aged 15 to 49 at 33.4

percent, the highest in the world. Two-thirds of Swaziland's roughly one million

people, ruled by sub-Saharan Africa's last executive monarch, live on US$2 or

less per day.

The report concluded, " Our projections show that both emigration and attrition

due to HIV/AIDS pose a serious double threat for Swaziland's health system,

which, if not effectively tackled, would mean the loss of 44 percent of the

nursing workforce in the public sector up to 2010. "

Nurses at St Theresa's, a clinic on the outskirts of Manzini run by the Roman

Catholic Church with financial support from government, last week held a crisis

meeting after two months of erratic salary payments or none at all.

" It is too hard doing what we do, under these conditions that you see, " a nurse

at the clinic told IRIN/PlusNews. The waiting room contains a few wooden

benches, with little ventilation to combat the stifling summer heat.

As a result of the government's policy of zero growth, no new posts were created

in over 20 years, even with the onset of the HIV/AIDS pandemic, which began to

bite in the mid 1990s. The World Health Organisation has put the total number of

health workers posts at 3,726.

" Some 758 of the 944 established nursing posts in the public and mission sectors

are filled. The nurse-to-population ratio in the public and mission sectors is

therefore around 70 per 100,000. The official number of nursing posts was widely

regarded as inadequate for the actual workload in the health sector, " the Kober

and Van Damme report commented.

The researchers estimated that 288 of the 758 nurses, about 38 percent, employed

in the public and mission sectors were probably HIV positive, of whom 29, or 10

percent of the HIV-positive nurses, might have died during 2005. They projected

that 3 percent to 4 percent of the entire nursing workforce would succumb to

AIDS-linked illnesses each year.

HIV/AIDS is a lesser contributor to the country's nursing shortage than

emigration. Researchers found that 100 of the national nursing workforce of

about 800 leave the country annually. Swaziland's two nursing colleges produce

about 80 to 90 graduates per year, while a school for nursing assistants

delivers around 20 graduates.

Although the two training sites receive hundreds of applicants annually, too few

student bursaries from the health and social welfare ministry, a lack of

teaching staff and student accommodation, and insufficient opportunities for

practical training have kept enrolment low.

A basic nursing course last three years, but most students do either one

additional year to obtain a qualification in midwifery or a five-year course to

obtain a Bachelor in Nursing Sciences degree.

" I left nursing school and went right to work, like all my classmates. I worked

at the Mbabane Government Hospital [the country's largest health facility], and

right away I saw someone die because they couldn't get the medicines they

needed. This is why Swaziland loses more nurses to 'greener pastures', in my

opinion. And AIDS is making our work so much harder, " the nurse said.

The Kober and van Damme report said 80 percent of bed occupancy in the medical

and paediatric wards of government hospitals nationwide was HIV/AIDS-related.

" Doctors from a mission hospital estimated that five years ago they would spend

an average of five minutes per patient on a ward round, while presently this was

more likely to be 20 to 30 minutes. This was seen as a consequence of the

increasing number of terminally ill patients needing time-intensive care. There

is an increased demand for health services, and health workers speak of feeling

overwhelmed and burned out, " the authors said.

Nurses were granted a salary increase in 2005, but little could be done about

the poor working conditions; 21 nurses resigned from the Mbabane Government

Hospital in the same month that the salary increment came into effect.

On a previous visit to Swaziland, Kober and Van Damme found that public and

mission health facilities had 1,481 posts, but only 1,184 staff were reported as

actually working at the facilities, leaving 297, or 20 percent, of the posts

vacant.

To increase the number of nurses, the Ministry of Health has requested the

Ministry of Public Service to lift a ban on the recruitment of foreign nurses,

whose salaries would be paid by the Global Fund to Fight AIDS, Tuberculosis and

Malaria.

Another solution to the shortage of nurses might come from government's rollout

of antiretroviral drugs for people living with HIV. Though hampered by teething

problems this year, the rollout could reduce the number of chronic HIV/AIDS

patients, as well as throwing a lifeline to HIV-positive nurses.

" No one wants to talk about it, but Swaziland's AIDS problem is frightening

nurses. We are on the frontline of this battle, and it is easy for some to run

away from the danger, " the nurse commented. " It takes real patriotism and a

dedication to your calling as a nurse to work as a nurse in Swaziland today. "

jh/go/he/oa

[ENDS]

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December 11, 2006