Science Tuesday - Medical Supplement
Mar. 22nd, 2005 08:27 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
brdgt
TB Declines, but Not in Immigrants
By DONALD G. McNEIL Jr., The New York Times, March 22, 2005
Tuberculosis rates in the United States reached an all-time low in 2004, the Centers for Disease Control and Prevention announced last week. But they rose in 17 states, and states with large numbers of recent immigrants, including New York, New Jersey, Florida and California, accounted for most new cases.
Infection rates for Asians were 20 times as great as those of whites, and rates for blacks and Hispanics were 8 times as great as those of whites, the centers said. The overall number of cases, 14,511, was the lowest since recording began, in 1953.
The high rates for Asians "are a reflection of immigration patterns and TB rates in the countries of origin," said Dr. Kenneth Castro, director of the tuberculosis control division at the C.D.C. China and India have the most cases in the world, and there are relatively high rates in Vietnam and the Philippines.
More than half the cases in the United States were in people born overseas and probably first infected there, Dr. Castro said.
The higher rates for Hispanics and blacks reflect a combination of high rates in Mexico and the disproportionate rate of incarceration, homelessness and drug abuse among those populations, Dr. Castro said.
Cases of multi-drug-resistant tuberculosis, the most dangerous kind, also continued to decline. Only 114 people had drug-resistant strains in 2003, the last year they were measured; 86 of them were born abroad.
Dr. Castro attributed the decline to measures taken after an epidemic of drug-resistant strains broke out in the late 1980's. Now every tuberculosis patient is quickly tested for drug resistance, and doctors can change the regimens accordingly.
Also, he said, local clinics are more sophisticated at enticing patients to report daily for six to nine months to take their pills while a nurse watches. Some clinics offer sandwiches or vouchers for fast-food restaurants, some pay transportation costs, and some send workers to shelters for the homeless, subway platforms or other places where the homeless congregate.
"By making sure that people complete their therapy, you minimize drug resistance," Dr. Castro said.
Resistant strains can also be picked up from other victims.
Dr. Castro cited two recent outbreaks of such tuberculosis in high schools in Georgia and California, each from strains circulating abroad. "To me, that shows the importance of the U.S. being involved in controlling TB overseas," he said. "It's enlightened self-interest."
Public health authorities are eager for new tuberculosis drugs. The latest was introduced in the 60's, and drug companies rarely test new antibiotics against the disease.
I have to take issue with the CDC's assumptions here - they need to consider that new immigrants to the United States experience conditions extremely favorable to infection (poor housing, unfair labor practices, crowded housing, etc.). By focusing on the assumption that they arrive here with TB it devolves into the age-old discourse that America is healthy and any disease comes from elsewhere (which in turn leads to justification for immigration limits on undesirable immigrant populations). They are ignoring some really good scholarship on this issue.
CASES WITHOUT BORDERS: Battling Insects, Parasites and Politics
By DONALD G. McNEIL Jr., The New York Times, March 22, 2005
SOMJI, Nigeria - The reason for all the excitement, one public health doctor after another trooping into her mud-walled room to have a look, was that Patience Solomon had correctly hung her new royal blue mosquito net over the bed she shared with her 2-year-old son, James.
Mosquito nets are not terribly complicated, as long as you have something to suspend them from - in Mrs. Solomon's case, a hand-hewn rafter just at head-knocking height beneath her corrugated iron roof.
Permeating the nets with insecticide does take a little concentration.
A state health worker had just given a demonstration beneath the village's central baobab tree: take half a Coke bottle full of water and a big enamel bowl, mix in the sachet of white powder, dunk the net, and let dry. Remember to rinse out the bowl before making food in it. (If you forget, it's not a disaster; the lambdacyhalotrin is more lethal to bugs than to children.)
Mosquito nets are technically very simple but in their own mundane way, in rural Africa, they are highly political objects.
Somji, a hot, dry collection of mud compounds in the sorghum and millet fields of Nigeria's central plateau, is one of the special weapons and tactics laboratories in the global struggle over mosquito net policy - a "piggybacking village."
"This is the first place in the history of the country where we're combining the distribution of bed nets with the distribution of drugs," said Dr. Emmanuel Miri, chief of Nigerian operations for the Carter Center in Atlanta.
The drugs are for lymphatic filariasis, a disease caused by eight-inch worms that ball up and nest in the lymph glands, clogging them until victims' legs swell to the thickness of an elephant's. There is no cure for the leg, nor do the worms die, but, given once a year to everyone in the village, the drugs Mectizan and Albendazole, donated by Merck and GlaxoSmithKline, kill the worms' microscopic progeny as they circulate in the blood.
Unable to reproduce, the infestation dies out when the adult worms shrivel up of old age, in about five years. But there is an exception: the drugs cannot be given to children under 5 or to pregnant women.
Normally, they go unprotected, hoping to shelter under the umbrella of "herd immunity" created when the rest of the village is de-wormed. (When herd immunity works, the uninfected have benefited from a combination of preventive medicine and dumb luck.)
But pregnant women and children under 5 are also the most likely to die of malaria. And malaria, like lymphatic filariasis, is spread by mosquitoes.
James had already had malaria once, Mrs. Solomon said.
Asked what she gave him for it, she produced a bottle whose label she could not read. It turned out to be a local brand of Tylenol, meaning that James had already had a serious stroke of luck with one fatal disease.
The Carter Center, a health and peace organization founded by former President Jimmy Carter, has been handing out de-worming drugs in Nigeria since the 1980's. It has no budget for mosquito nets. But Roll Back Malaria, a World Health Organization campaign started in 1998, does, has some money because malaria is relatively "hot" at the moment, thanks to the Global Fund to Fight AIDS, Tuberculosis and Malaria. So in Somji, the two programs are piggybacking, meaning everyone in each family should get either Carter drugs or a W.H.O. net.
But that requires juggling layers of bureaucracy, since the W.H.O. sends its donation through the Nigerian federal government, which filters the nets down to state governments, which send out workers to do demonstrations. In the two central states where the program is centered, Niger and Plateau, three million people get the drugs. The two states received only 60,000 nets. (Nigeria has more than 100 million people, and no national program.)
What will happen when those run out?
"That is why we are begging you people to come to our aid," said Rachel Titi Bitrus, the net-dunking Health Ministry demonstrator. "We pray maybe we will get some more."
Equally good nets are sold at roadside markets, but they are several hours away on foot and cost from $6.50 to $14, she said, adding, "Many complain that that is too dear."
Big donors and their consultants are deeply divided on whether mosquito nets, like condoms, should be distributed by "social marketing" in which donated goods are not distributed free, but advertised as rival brands with catchy names and sold for nominal sums.
Some economists argue that poor Africans value and use only things they have paid for. Others retort that such schemes benefit only the "richest of the poor," like city dwellers who can afford cigarettes, while the poorest poor - peasant farmers in dirt-track villages like Somji, who bear the greatest burden of mosquito diseases - die for lack of items the West can mass-produce for pennies.
Officials from the United States Agency for International Development favor social marketing of nets; those from the Centers for Disease Control and Prevention oppose it. Unicef favors it; W.H.O. opposes it.
And even if the macroeconomic disputes are resolved, there are micro problems. Somji is a two-hour drive from the regional capital, Jos, but Mrs. Bitrus has only occasional use of a truck. The Carter Center program relies on a network of volunteers from thousands of tiny villages, the kinds of places where ownership of a bicycle or a radio puts the owner in an upper-income bracket.
"The same guy who used to ride his bike to pick up a box of meds now has to somehow pick up a ton of bed nets," said Dr. Frank O. Richards Jr., a parasitologist at the C.D.C. who advises the Carter Center. "They've got to figure that out. "
Dr. Richards was watching the volunteers juggle the new complexities. With pigs rooting at their feet, they stood outside a compound, called out each resident by name, and spooned out pills.
One 5-year-old gagged on his fat Albendazole tablet. "Let him chew it! Tell him he can chew it!" Dr. Richards shouted, trying to get his words translated from English to Hausa to the village language.
"What about the baby?" he asked aloud, when the volunteers had dosed a nursing mother and said they were finished. "He's supposed to get a net," he muttered. "This is the crucial thing. They didn't even think about babies before."
The volunteers explained that they wanted to do that later in the day. Their data-recording system consisted of two lined primary school notebooks, one for pills and one for nets, and doing both at once would sow confusion.
Hence the eventual excitement about Mrs. Solomon. The successful hoisting of her net - made in Kenya, paid for in Geneva, arranged for in Atlanta, demonstrated in Somji - was no simple matter.
The next move, Dr. Richards said, would be a surprise visit in a few weeks. Now that nets had value, he said, "we'll want to see if the right people are using them - or if all the fathers are sleeping under them."
As the team climbed into its trucks to leave, a loud argument broke out. A visitor from another village was shouting at a Carter Center volunteer, accusing him of handing out nets free here while dignitaries were watching, but charging his village 80 cents each. Dr. Miri stepped out of his truck, questioned the volunteer, fired him on the spot and asked the village chief to pick another.
The team left; the politics went on.
"Some economists argue that poor Africans value and use only things they have paid for." - I find this line of thinking extremely harmful and downright ridiculous - Poor Africans don't care about their health? Please.
Q & A: Illness in Childhood
By C. CLAIBORNE RAY, The New York Times, March 22, 2005
Q. Is it true that diseases are worse when you get them as an adult?
A. "Some are worse and some are not," said Dr. Larry Pickering of the Centers for Disease Control and Prevention in Atlanta. "We don't know specifically why."
It has been suggested that the adult immune system pours out substances called cytokines in an oversupply, causing the body to overreact to infection so that symptoms are somewhat worse, Dr. Pickering said.
For example, he said, shingles, the progressive disease caused by recurrent varicella, the chickenpox virus, occurs more often in older adolescents, adults, immune-compromised children and pregnant women than in most children, suggesting that the common thread may involve the immune system.
Another disease that is worse in adults is hepatitis A, he said. A child under 4 years old who gets the infection may have a mild illness or be asymptomatic, but 70 to 80 percent of the adults become fairly ill if they have not had the disease before.
On the other hand, Dr. Pickering said, "The hemophilus infection is bad in whoever gets it, but in children you see epiglottitis, an inflammation of the throat structure, which can cause death by blocking breathing, and you don't see that in adults." He also said that ear infections, common in children, are rare in adults. The best way to address many of these illnesses in young and old is vaccination, if it is available.
He noted that parents used to hold parties to expose their children to some childhood diseases.
"This would be good if we had crystal balls," he said, "but in the case of chickenpox, some children would get a mild disease, but some would die."
African Artists Raise Voices Against Malaria
By LYDIA POLGREEN, The New York Times, March 20, 2005
DAKAR, Senegal - As far as causes go, malaria may well be the least trendy. Luckily, when more than a dozen African musical superstars converged on this coastal capital to strut their stuff against the disease, Africa's most persistent scourge, the organizers thought to invite the singer Corneille.
"Corneille, I love you," the young women screeched as he took the stage on a recent Saturday evening, his pectoral muscles bulging through a white embroidered shirt, Hugo Boss underwear peeking out of his low-slung blue jeans. When he started to sing a ballad, one young woman swooned and had to be carried away by the police. Another screamed and shook her head hysterically; yet another waved a sign that read, "Welcome back to Africa!"
Corneille, a Rwandan who fled the genocide in 1994 and became a pop star in Canada, was the fourth act in Africa Live, a two-day megaconcert billed as an all-African version of Live Aid, the groundbreaking concert held to raise money to fight the deadly famine that gripped Ethiopia in the 1980's.
This time, however, the concert was held by Africans and for Africans, to raise money and awareness to fight one of Africa's often forgotten killers, malaria. Despite being relatively easy to prevent and treat, malaria kills well over a million people a year worldwide - estimates vary - most of them children.
Youssou N'Dour, the Grammy-winning Senegalese singer, recited these statistics, shaking his head in disbelief, in a backstage interview as he waited to perform to a surging crowd of 20,000 in Dakar's main stadium.
"When I learned that malaria kills so many people just because they can't get simple medicine or a net to cover their beds, I said, 'This is not possible, we must do something,' " he recalled, massaging his vocal cords. "It is like a tsunami every day here in Africa, only it happens slowly so no one notices, no one pays attention. So we have to bring the attention ourselves."
A plan to hold a concert with a big lineup of stars from across Africa was already under way, so Mr. N'Dour decided to join that effort by Roll Back Malaria, an organization that aims to cut the burden of malaria in half by 2010. Profits will largely come from the broadcast and videos of the concert, which organizers hope will reach a billion people worldwide.
Mr. N'Dour, who enjoys a sort of demigod status here, even wrote an antimalaria anthem, urging Africans to take precautions against mosquito bites and to clean up standing water that could act as breeding grounds for the insects.
The concert occurred at an auspicious moment in Africa's history, when other nations are turning their attention to this continent's most recalcitrant problems, promising to increase aid to fight poverty. Whether it is the United Nations Millennium Development Goals, which aim, among other things, to halve extreme poverty by 2015, or a British report that called for a huge increase in aid to Africa, the continent that long seemed forgotten is finally being remembered.
That may explain why malaria has suddenly become a celebrated cause.
The facts about malaria's devastating effects have been well known for a century. That may be why the disease has received much less attention than AIDS, which has devastated Africa but still infects fewer people. Indeed, Malaria affects twice as many people as AIDS, measles, leprosy and tuberculosis combined, according to Roll Back Malaria, and every day 3,000 children die of the disease. It eats up 40 percent of public heath spending, and costs developing countries $12 billion a year in lost productivity. It hurts Africa, particularly African children, the most: 90 percent of malaria deaths occur in Africa.
Yet many affordable means to fight the disease exist.
"It is the lowest-hanging fruit," said Jeffrey D. Sachs, the economist and antipoverty crusader, who attended the concert. "We are talking about $5 nets and inexpensive pills to save thousands upon thousands of lives."
Behind the concert is a new approach, Dr. Sachs said, that emphasizes simply giving away nets rather than trying to sell them at a reduced price, which has been the traditional distribution method.
"How can you sell something to someone who has no money?" he said. "It just doesn't make sense."
Onstage the entertainers did not bore their audience with lectures about insecticide-treated nets and antifever pills. They stuck to what they knew best. Salif Keita, the Malian singer, strutted on the stage, belting his shrill anthems to a spellbound audience. Baaba Maal, on his home turf, pranced barefoot around his kora player, and Angelique Kidjo, the songbird of Benin, serenaded the crowd with a tender rendition of the classic Swahili love song, "Malaika."
Of course there was Corneille, who got perhaps the most rousing response, from a largely female audience. When he left the stage to try to shake hands with the adoring crowd, he nearly set off a riot and had to be carried back onstage.
As he prepared for his final performance, which would end the show, Mr. N'Dour said musicians held a special place in the African imagination, making them the best agents of progress and change.
"We are guardians of Africa's diamond, its shining jewel, our culture," he said. "It has sustained us for so long, and now it can move us forward."
By DONALD G. McNEIL Jr., The New York Times, March 22, 2005
Tuberculosis rates in the United States reached an all-time low in 2004, the Centers for Disease Control and Prevention announced last week. But they rose in 17 states, and states with large numbers of recent immigrants, including New York, New Jersey, Florida and California, accounted for most new cases.
Infection rates for Asians were 20 times as great as those of whites, and rates for blacks and Hispanics were 8 times as great as those of whites, the centers said. The overall number of cases, 14,511, was the lowest since recording began, in 1953.
The high rates for Asians "are a reflection of immigration patterns and TB rates in the countries of origin," said Dr. Kenneth Castro, director of the tuberculosis control division at the C.D.C. China and India have the most cases in the world, and there are relatively high rates in Vietnam and the Philippines.
More than half the cases in the United States were in people born overseas and probably first infected there, Dr. Castro said.
The higher rates for Hispanics and blacks reflect a combination of high rates in Mexico and the disproportionate rate of incarceration, homelessness and drug abuse among those populations, Dr. Castro said.
Cases of multi-drug-resistant tuberculosis, the most dangerous kind, also continued to decline. Only 114 people had drug-resistant strains in 2003, the last year they were measured; 86 of them were born abroad.
Dr. Castro attributed the decline to measures taken after an epidemic of drug-resistant strains broke out in the late 1980's. Now every tuberculosis patient is quickly tested for drug resistance, and doctors can change the regimens accordingly.
Also, he said, local clinics are more sophisticated at enticing patients to report daily for six to nine months to take their pills while a nurse watches. Some clinics offer sandwiches or vouchers for fast-food restaurants, some pay transportation costs, and some send workers to shelters for the homeless, subway platforms or other places where the homeless congregate.
"By making sure that people complete their therapy, you minimize drug resistance," Dr. Castro said.
Resistant strains can also be picked up from other victims.
Dr. Castro cited two recent outbreaks of such tuberculosis in high schools in Georgia and California, each from strains circulating abroad. "To me, that shows the importance of the U.S. being involved in controlling TB overseas," he said. "It's enlightened self-interest."
Public health authorities are eager for new tuberculosis drugs. The latest was introduced in the 60's, and drug companies rarely test new antibiotics against the disease.
I have to take issue with the CDC's assumptions here - they need to consider that new immigrants to the United States experience conditions extremely favorable to infection (poor housing, unfair labor practices, crowded housing, etc.). By focusing on the assumption that they arrive here with TB it devolves into the age-old discourse that America is healthy and any disease comes from elsewhere (which in turn leads to justification for immigration limits on undesirable immigrant populations). They are ignoring some really good scholarship on this issue.
CASES WITHOUT BORDERS: Battling Insects, Parasites and Politics
By DONALD G. McNEIL Jr., The New York Times, March 22, 2005
SOMJI, Nigeria - The reason for all the excitement, one public health doctor after another trooping into her mud-walled room to have a look, was that Patience Solomon had correctly hung her new royal blue mosquito net over the bed she shared with her 2-year-old son, James.
Mosquito nets are not terribly complicated, as long as you have something to suspend them from - in Mrs. Solomon's case, a hand-hewn rafter just at head-knocking height beneath her corrugated iron roof.
Permeating the nets with insecticide does take a little concentration.
A state health worker had just given a demonstration beneath the village's central baobab tree: take half a Coke bottle full of water and a big enamel bowl, mix in the sachet of white powder, dunk the net, and let dry. Remember to rinse out the bowl before making food in it. (If you forget, it's not a disaster; the lambdacyhalotrin is more lethal to bugs than to children.)
Mosquito nets are technically very simple but in their own mundane way, in rural Africa, they are highly political objects.
Somji, a hot, dry collection of mud compounds in the sorghum and millet fields of Nigeria's central plateau, is one of the special weapons and tactics laboratories in the global struggle over mosquito net policy - a "piggybacking village."
"This is the first place in the history of the country where we're combining the distribution of bed nets with the distribution of drugs," said Dr. Emmanuel Miri, chief of Nigerian operations for the Carter Center in Atlanta.
The drugs are for lymphatic filariasis, a disease caused by eight-inch worms that ball up and nest in the lymph glands, clogging them until victims' legs swell to the thickness of an elephant's. There is no cure for the leg, nor do the worms die, but, given once a year to everyone in the village, the drugs Mectizan and Albendazole, donated by Merck and GlaxoSmithKline, kill the worms' microscopic progeny as they circulate in the blood.
Unable to reproduce, the infestation dies out when the adult worms shrivel up of old age, in about five years. But there is an exception: the drugs cannot be given to children under 5 or to pregnant women.
Normally, they go unprotected, hoping to shelter under the umbrella of "herd immunity" created when the rest of the village is de-wormed. (When herd immunity works, the uninfected have benefited from a combination of preventive medicine and dumb luck.)
But pregnant women and children under 5 are also the most likely to die of malaria. And malaria, like lymphatic filariasis, is spread by mosquitoes.
James had already had malaria once, Mrs. Solomon said.
Asked what she gave him for it, she produced a bottle whose label she could not read. It turned out to be a local brand of Tylenol, meaning that James had already had a serious stroke of luck with one fatal disease.
The Carter Center, a health and peace organization founded by former President Jimmy Carter, has been handing out de-worming drugs in Nigeria since the 1980's. It has no budget for mosquito nets. But Roll Back Malaria, a World Health Organization campaign started in 1998, does, has some money because malaria is relatively "hot" at the moment, thanks to the Global Fund to Fight AIDS, Tuberculosis and Malaria. So in Somji, the two programs are piggybacking, meaning everyone in each family should get either Carter drugs or a W.H.O. net.
But that requires juggling layers of bureaucracy, since the W.H.O. sends its donation through the Nigerian federal government, which filters the nets down to state governments, which send out workers to do demonstrations. In the two central states where the program is centered, Niger and Plateau, three million people get the drugs. The two states received only 60,000 nets. (Nigeria has more than 100 million people, and no national program.)
What will happen when those run out?
"That is why we are begging you people to come to our aid," said Rachel Titi Bitrus, the net-dunking Health Ministry demonstrator. "We pray maybe we will get some more."
Equally good nets are sold at roadside markets, but they are several hours away on foot and cost from $6.50 to $14, she said, adding, "Many complain that that is too dear."
Big donors and their consultants are deeply divided on whether mosquito nets, like condoms, should be distributed by "social marketing" in which donated goods are not distributed free, but advertised as rival brands with catchy names and sold for nominal sums.
Some economists argue that poor Africans value and use only things they have paid for. Others retort that such schemes benefit only the "richest of the poor," like city dwellers who can afford cigarettes, while the poorest poor - peasant farmers in dirt-track villages like Somji, who bear the greatest burden of mosquito diseases - die for lack of items the West can mass-produce for pennies.
Officials from the United States Agency for International Development favor social marketing of nets; those from the Centers for Disease Control and Prevention oppose it. Unicef favors it; W.H.O. opposes it.
And even if the macroeconomic disputes are resolved, there are micro problems. Somji is a two-hour drive from the regional capital, Jos, but Mrs. Bitrus has only occasional use of a truck. The Carter Center program relies on a network of volunteers from thousands of tiny villages, the kinds of places where ownership of a bicycle or a radio puts the owner in an upper-income bracket.
"The same guy who used to ride his bike to pick up a box of meds now has to somehow pick up a ton of bed nets," said Dr. Frank O. Richards Jr., a parasitologist at the C.D.C. who advises the Carter Center. "They've got to figure that out. "
Dr. Richards was watching the volunteers juggle the new complexities. With pigs rooting at their feet, they stood outside a compound, called out each resident by name, and spooned out pills.
One 5-year-old gagged on his fat Albendazole tablet. "Let him chew it! Tell him he can chew it!" Dr. Richards shouted, trying to get his words translated from English to Hausa to the village language.
"What about the baby?" he asked aloud, when the volunteers had dosed a nursing mother and said they were finished. "He's supposed to get a net," he muttered. "This is the crucial thing. They didn't even think about babies before."
The volunteers explained that they wanted to do that later in the day. Their data-recording system consisted of two lined primary school notebooks, one for pills and one for nets, and doing both at once would sow confusion.
Hence the eventual excitement about Mrs. Solomon. The successful hoisting of her net - made in Kenya, paid for in Geneva, arranged for in Atlanta, demonstrated in Somji - was no simple matter.
The next move, Dr. Richards said, would be a surprise visit in a few weeks. Now that nets had value, he said, "we'll want to see if the right people are using them - or if all the fathers are sleeping under them."
As the team climbed into its trucks to leave, a loud argument broke out. A visitor from another village was shouting at a Carter Center volunteer, accusing him of handing out nets free here while dignitaries were watching, but charging his village 80 cents each. Dr. Miri stepped out of his truck, questioned the volunteer, fired him on the spot and asked the village chief to pick another.
The team left; the politics went on.
"Some economists argue that poor Africans value and use only things they have paid for." - I find this line of thinking extremely harmful and downright ridiculous - Poor Africans don't care about their health? Please.
Q & A: Illness in Childhood
By C. CLAIBORNE RAY, The New York Times, March 22, 2005
Q. Is it true that diseases are worse when you get them as an adult?
A. "Some are worse and some are not," said Dr. Larry Pickering of the Centers for Disease Control and Prevention in Atlanta. "We don't know specifically why."
It has been suggested that the adult immune system pours out substances called cytokines in an oversupply, causing the body to overreact to infection so that symptoms are somewhat worse, Dr. Pickering said.
For example, he said, shingles, the progressive disease caused by recurrent varicella, the chickenpox virus, occurs more often in older adolescents, adults, immune-compromised children and pregnant women than in most children, suggesting that the common thread may involve the immune system.
Another disease that is worse in adults is hepatitis A, he said. A child under 4 years old who gets the infection may have a mild illness or be asymptomatic, but 70 to 80 percent of the adults become fairly ill if they have not had the disease before.
On the other hand, Dr. Pickering said, "The hemophilus infection is bad in whoever gets it, but in children you see epiglottitis, an inflammation of the throat structure, which can cause death by blocking breathing, and you don't see that in adults." He also said that ear infections, common in children, are rare in adults. The best way to address many of these illnesses in young and old is vaccination, if it is available.
He noted that parents used to hold parties to expose their children to some childhood diseases.
"This would be good if we had crystal balls," he said, "but in the case of chickenpox, some children would get a mild disease, but some would die."
African Artists Raise Voices Against Malaria
By LYDIA POLGREEN, The New York Times, March 20, 2005
DAKAR, Senegal - As far as causes go, malaria may well be the least trendy. Luckily, when more than a dozen African musical superstars converged on this coastal capital to strut their stuff against the disease, Africa's most persistent scourge, the organizers thought to invite the singer Corneille.
"Corneille, I love you," the young women screeched as he took the stage on a recent Saturday evening, his pectoral muscles bulging through a white embroidered shirt, Hugo Boss underwear peeking out of his low-slung blue jeans. When he started to sing a ballad, one young woman swooned and had to be carried away by the police. Another screamed and shook her head hysterically; yet another waved a sign that read, "Welcome back to Africa!"
Corneille, a Rwandan who fled the genocide in 1994 and became a pop star in Canada, was the fourth act in Africa Live, a two-day megaconcert billed as an all-African version of Live Aid, the groundbreaking concert held to raise money to fight the deadly famine that gripped Ethiopia in the 1980's.
This time, however, the concert was held by Africans and for Africans, to raise money and awareness to fight one of Africa's often forgotten killers, malaria. Despite being relatively easy to prevent and treat, malaria kills well over a million people a year worldwide - estimates vary - most of them children.
Youssou N'Dour, the Grammy-winning Senegalese singer, recited these statistics, shaking his head in disbelief, in a backstage interview as he waited to perform to a surging crowd of 20,000 in Dakar's main stadium.
"When I learned that malaria kills so many people just because they can't get simple medicine or a net to cover their beds, I said, 'This is not possible, we must do something,' " he recalled, massaging his vocal cords. "It is like a tsunami every day here in Africa, only it happens slowly so no one notices, no one pays attention. So we have to bring the attention ourselves."
A plan to hold a concert with a big lineup of stars from across Africa was already under way, so Mr. N'Dour decided to join that effort by Roll Back Malaria, an organization that aims to cut the burden of malaria in half by 2010. Profits will largely come from the broadcast and videos of the concert, which organizers hope will reach a billion people worldwide.
Mr. N'Dour, who enjoys a sort of demigod status here, even wrote an antimalaria anthem, urging Africans to take precautions against mosquito bites and to clean up standing water that could act as breeding grounds for the insects.
The concert occurred at an auspicious moment in Africa's history, when other nations are turning their attention to this continent's most recalcitrant problems, promising to increase aid to fight poverty. Whether it is the United Nations Millennium Development Goals, which aim, among other things, to halve extreme poverty by 2015, or a British report that called for a huge increase in aid to Africa, the continent that long seemed forgotten is finally being remembered.
That may explain why malaria has suddenly become a celebrated cause.
The facts about malaria's devastating effects have been well known for a century. That may be why the disease has received much less attention than AIDS, which has devastated Africa but still infects fewer people. Indeed, Malaria affects twice as many people as AIDS, measles, leprosy and tuberculosis combined, according to Roll Back Malaria, and every day 3,000 children die of the disease. It eats up 40 percent of public heath spending, and costs developing countries $12 billion a year in lost productivity. It hurts Africa, particularly African children, the most: 90 percent of malaria deaths occur in Africa.
Yet many affordable means to fight the disease exist.
"It is the lowest-hanging fruit," said Jeffrey D. Sachs, the economist and antipoverty crusader, who attended the concert. "We are talking about $5 nets and inexpensive pills to save thousands upon thousands of lives."
Behind the concert is a new approach, Dr. Sachs said, that emphasizes simply giving away nets rather than trying to sell them at a reduced price, which has been the traditional distribution method.
"How can you sell something to someone who has no money?" he said. "It just doesn't make sense."
Onstage the entertainers did not bore their audience with lectures about insecticide-treated nets and antifever pills. They stuck to what they knew best. Salif Keita, the Malian singer, strutted on the stage, belting his shrill anthems to a spellbound audience. Baaba Maal, on his home turf, pranced barefoot around his kora player, and Angelique Kidjo, the songbird of Benin, serenaded the crowd with a tender rendition of the classic Swahili love song, "Malaika."
Of course there was Corneille, who got perhaps the most rousing response, from a largely female audience. When he left the stage to try to shake hands with the adoring crowd, he nearly set off a riot and had to be carried back onstage.
As he prepared for his final performance, which would end the show, Mr. N'Dour said musicians held a special place in the African imagination, making them the best agents of progress and change.
"We are guardians of Africa's diamond, its shining jewel, our culture," he said. "It has sustained us for so long, and now it can move us forward."
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Date: 2005-03-22 03:57 pm (UTC)And I was serious when I asked if you wanted to make some caps for me. I think they're super cute !
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Date: 2005-03-22 04:00 pm (UTC)no subject
Date: 2005-03-22 04:02 pm (UTC)Let me know how much and I'll be more than happy to pay for them.
thanks, bay-beee !