AHILA 10 Congress 2006

Learning from Africa 

Here in Mombassa, Kenya, AHILA (Association for Health Information in Africa) has brought together 120 people from 27 African countries to share their experiences and hopes in bringing information to health providers and the public, and sharing Africa's wealth of local content both intra-continentally and around the world. This morning the conference room, which looks out on the Indian Ocean, was filled with people in African dress with their beautiful colors, patterns, and styles differing according to the person's country. Typing as fast as I could as people introduced themselves, I recorded these: Senegal, Benin, Mozambique, Cote d'Ivoire, Botswana, Kenya, Zimbabwe, Malawi, Tanzania, Mali, Sierra Leon, Ghana, Uganda, Swaziland, South Africa, Ethiopia, Burundi, Seychelles, Zambia, Congo, and Swaziland. Several people also are here from the UK and the US.

AHILA began 22 years ago in Nairobi, and everyone is celebrating that this is AHILA's 10th conference. Many of the people here have worked together since the beginning and it is an honor to witness this strong, warm community which is passionately dedicated to African health.

As the conference theme is "Millennium Development Goals and Health Information Provision in Africa," many presenters have noted that health drives development and that development drives health. From my "chronic disease" perspective, I see in addition that development drives ill health. With improved economies and globalization come cars, sedentary jobs, processed foods, smoking, and new stresses, producing new health challenges.

During a breakfast conversation, I mentioned to a medical librarian from Nigeria that I hoped Africa would be able to look ahead at the long-term health consequences of CVD and thus avoid the health mistakes of the US and other developed countries. She responded swiftly and strongly: "There are reasons why the future is not important to people who cannot find food and shelter for today." Of course she is right. I have seen people walking miles carrying water and wood or tending emaciated animals, or simply sitting under trees doing nothing. I realized how much of my own thinking is future-oriented and reflected on what it would be like to perhaps not believe one would have much of a future or perhaps even not desire one. And while much of Africa is undernourished, I explained that in many African countries, heart disease is already the primary cause of death, and that in the rapidly growing urbanized African settings, where people find employment and are confronted with the media's glamorized portrayal of Western lifestyles, the trend toward fast food and sedentary behaviors, and diseases such a hypertension and diabetes, is inexorable. She was startled but immediately grasped the urgency of this new health challenge and her role in disseminating information to help prevent it. It was a moment of mutual learning for which I am grateful.

Later at dinner I spoke with another Nigerian and asked her whether the physicians and medical students she works with indicate a need for information about chronic disease, and whether heart health information is conveyed to patients. Young, beautiful, and fit, she told me her story: She had been overweight and developed hypertension, which other family members also have. Her doctor advised her to lose weight, which she successfully did, and she began taking medication. Her hypertension is now controlled and thanks to her encouragement and education, her parents' blood pressure is also controlled. She is now part of the ProCor email network and will help us disseminate information to her constituency and share with us their issues and experiences.

A final observation-experiencing Africa's technology challenges firsthand is another lesson I will take away with me. The AHILA conference is located at a fine resort and is top-notch in every way. Still it is not unusual for power to go out unannounced (documents lost, emails unsent), or for the internet connection to be down. The business center charges about US$10 an hour for one of their 3 computers but it takes an great amount of time to get online, read or send email, or post something to the ProCor discussion. There is little I can accomplish during the half-hour tea breaks. I have had to stop reading any of the news or discussions I subscribe to, and I now know better than to open an attachment or link to a website for fear of missing the next session while I wait for it to open. When the business office is closed, wireless access is possible if one sits in the lobby next door; the lobby has no walls and is open to the sound of the ocean and the rustling palms but also unfortunately to hungry mosquitoes.

I am not complaining, indeed I am overwhelmed with gratitude for this experience of Africa, Mombassa's multicultural markets and ancient mosques, and Tsavo National Park's giraffes and elephants, meeting people and feeling their warmth, being with so many other health communicators from whom I have so much to learn. As Bernard Nkum observed when we first reunited here, "Catherine, you are like a newborn baby in Africa." He was referring to my immune system but there is so much here to marvel at, honor, and learn from that certainly he is right.

24 October 2006

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A Ghanaian cardiologist's perspective

Bernard Nkum, MD: So far the focus of the conference appears to be on infectious diseases. I have yet to hear anyone mention CVD or any other chronic disease. Presentations thus far have focused on how information technology can address reproductive health, HIV/AIDS, malaria, tb, etc. In part this may be because Central and East Africa, where many participants are from, have relatively high prevalence of AIDS and other infectious disease such as ebola, marbung, yellow fever, etc. Generally there is a huge investment into getting information to the public in particular so they can be well informed about infectious disease. ProCOR could potentially tap into these networks and the information infrastructure available. With infectious diseases now being fairly controlled, the opportunity should not be missed to forcibly to bring home the issue of CVD prevention.

There exist local data and other knowledge which has to be analyzed and presented to the wider world. There is a lot of information in Africa that has not been packaged and presented for the wider community. I believe than ProCor could be a useful channel for Africa's knowledge and experience to reach the rest of the world. The conference is an ideal opportunity for discussing how this might be done.

24 October 2006

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AHILA's role in Africa's heart health

ProCor's presentation at the Association for Health Information and Libraries in Africa Congress began with a medical focus because chronic diseases did not appear on the conference program, nor are they included among the MDGs (the conference theme was "Millennium Development Goals and Health Information Provision in Africa). Several speakers noted that good health drives development and that development can contribute to health but, from the perspective of chronic disease, development drives poor health.

AHILA's medical librarians and health information professionals can be an important change agent by placing the wake up call to Africa and by providing people with the informational resources to avert this epidemic. The time to begin communicating about CVD is now and AHILA's librarians and health information specialists, who are the key conduit of medical information for health workers, are the ones to do it.

Several themes emerged during the week's presentations and discussions which underscore the powerful potential of ProCor and AHILA:

• Accessible formats: Email is still a critically needed format for information delivery. Some medical libraries have internet access but many do not. In a Sierra Leone medical library, access is limited to two hours a day; the librarians we met told us that they must use internet cafes after work, which they pay for out-of-pocket. Margaret Mgwira, University of Malawi, reported that bandwidth that costs $10 per month in the US would cost $3000 per month for equivalent bandwidth in Malawi-"hardly a level plaing field," as she put it.
• Uneven access across the continent: While some libraries have no internet access at all, a colleague from Mali described the use of telemedicine for allowing surgeons in Mali to follow a surgical operation in Switzerland. "The Swiss doctor even stood and asked questions and the doctors in Mali gave their interpretations of what was happening. We are quite advanced in Mali, we have been doing this for 5 years." Lenny Rhine, a long-time US-based AHILA supporter, described this as the "divide within the divide"-disparities between urban sectors with academic health centers and rural primary care areas in terms of access to information, or between countries or parts of countries.
• Learning from Africa: Many presentors testified to the richness of local knowledge and experience in Africa and expressed frustration with the scarcity of channels through which it can achieve visibility, including difficulty publishing in international peer-reviewed journals and the limited reach of local journals. ProCor offers a regional and global platform for disseminating local content to inform other efforts and influence global agenda setting.
• Competition for scarce health resources: How is Africa to contend with CVD when it must continue to address health issues like HIV/AIDS and malaria and overarching issues like poverty? ProCor strives to provide content that is useful in low-resource settings and that builds on human rather than technological capacity.

Response to ProCor's presentation was resoundingly positive.

Dr Frederick Bukachi, a Kenyan cardiologist and co-director of Global Healthcare Information Network, pointed out to the group that over-nutrition now exceeds under-nutrition globally and asked, "Who in this room doesn't know someone affected by hypertension, stroke, diabetes, or other CVD-related diseases?"

A nutritionist spoke of the need to begin prevention in early childhood: "Medics need to work closely with nutritionists. Scientific evidence indicates that these problems begin early in childhood. We have a key window of opportunity to intervene between birth and age two, to ensure adequate infant feeding. When complementary feeding is introduced early, children get overweight and later we will see these same children obese. That's something that can't be reversed."

In response to a question about how librarians should respond to inquiries about traditional medicines, Mbaabu Mathiu, University of Nairobi, noted that "traditional medicine is being used and traditional healers are treating chronic diseases. There is very little data on herbal medicine. Kenya Medical Research Institute (KEMRI), a center for traditional medicine, is researching what's used by traditional healers and medical practitioners. The decade 2001-2010 has been declared the Decade for African Traditional Medicine. If we are getting chronic diseases because our diets are changing, then we need to look at what our forefathers were eating-- go back and look at medicinal foods."

Many participants signed up to become part of ProCor's email network on the spot, and thanks to WHO's support, copies of "Chronic disease: A vital investment," in French and English, were distributed to participants.

Later that day, Marion Chibambo, University of Swaziland, summed up the importance of AHILA's role in preventing cardiovascular disease in Africa: "We are killing ourselves slowly with our heartbeats."

29 October 2006

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CVD--Africa's new health threat

The AHILA congress concluded on Friday in Mombasa, Kenya. Of the more than 30 excellent presentations none mentioned chronic disease. The goal of ProCor's presentation by Bernard Nkum, MD, Ghana editor and Catherine Coleman, Editor in Chief, was to create awareness of CVD in Africa among the participants, who provide the primary channels for delivering health information, and to engage them in ProCor's email network. Following is a transcript of the first part of ProCor's presentation, which was delivered by Dr. Bernard Nkum, MD.

Dr. Bernard Nkum: There is a new global epidemic of chronic diseases, which include heart disease, stroke, diabetes, cancer, and respiratory disease. In almost all countries this constitutes a major cause of death. Globally, cardiovascular disease and diabetes mellitus cause three times as many deaths as HIV/AIDS, tuberculosis, and malaria combined. In the middle and lower income countries, 80% of deaths are due to chronic disease. This then brings a double burden to the poor countries that are already grappling with infectious diseases. In poor countries, these conditions are affecting us at younger ages, are affecting men and women equally, and contribute to a vicious cycle of poverty and poor health.

The earliest recordings of heart were made in Africa in the Egyptian book of the dead. Today, heart disease constitutes a major health threat. CVD accounted for 8.2% of deaths in Africa in 1992 and ten years later this jumped up to 9.2%. This is happening all across Africa and it is escalating rapidly. Our health services, which are designed for acute infectious diseases, cannot adequately cope. We do not have adequate health capacity. Our doctors and nurses are leaving for greener pastures. We do not have adequate knowledge about cardiovascular disease or about preventive strategies.

What are the reasons for these new threats? Our population is aging, we are taking a lot of high-fat, sweet, and salty foods instead of fruits and vegetables. We are adopting a sedentary lifestyle. There is increased use of tobacco, especially among our young, and urbanization is spreading as people seek jobs, again with attendant stress. As economies grow, fast foods replace traditional cuisine. People use cars rather than bicycles or walking, and tobacco is skillfully marketed to our most vulnerable populations. The vast amount of cardiovascular disease can be attributed to conventional risk factors such as diabetes, hypertension, obesity, and high cholesterol in addition to tobacco use, inactivity, and low fruit and vegetable consumption.

What are the consequences of this in sub-Saharan Africa? At least 5% of all adult deaths here are due to hypertension. A study conducted in rural Nigeria in the 1990s found an excess mortality of 7 % due to hypertension. Uganda has a population of 28 million and more than 1 million or them are diabetic; 30 years ago, only 254 Ugandans were diagnosed with diabetes. If we move to the western end of the continent, a study done in the Gambia showed that the rural prevalence of obesity was only 4% but what is more significant is that nearly a third of urban women age 35 or older were obese. One out of three men in South Africa and half of South African women are overweight. If you go back home to my country, Ghana, a fifth of our boys and girls use tobacco-related products. Here in Kenya, 10% of our girls and 15%s of our boys use tobacco.

The good news is that 80% of these diseases are preventable. In terms of nutrition, we should take more fruit and vegetables, and less of salt, sugar, and fat. We should begin to increase our activity moderately. With respect to tobacco, we should prevent initiation, support cessation, and protect ourselves from secondhand smoke.

Developed countries such as the US, Australia, UK, and Canada which have adopted preventive strategies have significantly dropped their deaths due to CVD. If we take a middle income or upcoming economy like Poland, in a span of 10 years, from 1991 to 2002, by adopting these measures together with national policy, CVD deaths dropped by more than a third.

The time for prevention is now. Nigeria's president, Olusegan Obasajo, recent warned, "We cannot afford to say ‘we must tackle other diseases first-HIV/AIDS, malaria, tuberculosis-then we will deal with chronic diseases.' If we wait even 10 years, we will find that the problem is even larger and more expensive to address." Africa has demonstrated an ability to develop strategies to control and prevent HIV/AIDS. Let's use the same ability to prevent the new epidemic of CVDs.

30 October 2008

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Innovative partnering

Fort Jesus in Mombasa, Kenya, was carved out of coral limestone by the Portuguese more than five centuries ago. This month, visitors to Fort Jesus learn not only about Mombasa's history but also about HIV prevention thanks to an engaging, innovative exhibit developed by Kenya Family Health International (FHI) and the National Museums of Kenya.

The initiative was presented at the AHILA conference by Ms. A.W. Karanja, who urged participants to consider it a model that can be adapted for disseminating information about other health conditions.

FHI identified museums as popular spots attracting young people and developed the exhibit, which is touring Kenya's museums. Between August-October 2006 more than 100,000 youth and 10,000 adults have engaged in self-training through entertain and engaged in discussion sparked by the exhibit.

The exhibit includes entertaining components through which museum visitors learn about HIV prevention, self-care, and treatment. A wheel, similar to a roulette wheel, is divided into segments representing different sectors of society, such as family, economy, etc. The wheel is spun and when it stops, players discuss how HIV/AIDS affects that sector; by helping people understand that HIV/AIDS affects everyone, the game helps reduce stigma about the disease.

A unique gallery is filled with posters carrying messages on HIV/AIDS, through which museum visitors walk. New posters and messages are designed on an ongoing basis.

Capitalizing on the popularity of computer-based interaction, three computers installed in the exhibition room provide links to reliable, relevant websites for those who wish to learn more. A comic book character named "Sara" provides young people with a role model-someone they can admire and emulate-for delaying sexual debut and learning life skills such as decision-making.

Ms. Karanja encouraged conference participants to consider "opportunities such as recreational activities for providing health info outside the library or other traditional settings" to reach young people. She also emphasized the powerful role parents can play in educating children if they are prepared with the necessary information and skills.

Africa offers rich resources of experience and expertise that stand ready to be shared with other countries working to improve health.

For more information: Family Health International, www.fhi.or.ke.

31 October 2006

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Communication for prevention

At the AHILA10 Conference in Mombasa, Kenya, we met many health information colleagues from the East and Southern African regions, where the prevalence of HIV/AIDS is the highest in the world. Many of the excellent presentations focused on ways in which information technology is being used to address the AIDS challenge.

Information networks and other HIV/AIDS-related programming have been developed and implemented in Africa at the regional, national, provincial, and, most importantly, local levels. One of the presentations described Botswana's multi-faceted, audience-targeted stratgegies. Public radio broadcasts drama soap operas with characters portraying positive and negative health behaviors; other components include road shows, health chats, and a television program which helps primary and secondary school teachers develop skills to talk to students about HIV/AIDS.

The AIDS prevention movement has successfully learned how to target ordinary people in their homes, schools, restaurants, and other settings-in virtually every nook and cranny of their lives. People are surrounded by AIDS preventive strategies left, right, and center.

We would love to see the same level of enthusiasm and zeal go into placing CVD education and screening in hubs of daily activity, just as AIDS posters and condoms are.

Can we put "no smoking" signs in restaurants, hotels, and football parks? Heart health posters in toilets and bus stops? Can we train public health nurses to visit marketplaces and deliver information about healthy foods, or use public address systems to motivate shop owners to move around their shops instead of remaining sedentary for hours at a time? Supply simple "self-service" BP measurement devices in busy airports instead of portable defibrillators?

We heard of many successes at this conference, reflecting hard work, commitment, and skill in reaching people with health promotion in their daily lives. Can Africa's resources, capacity, and support be galvanized for CVD prevention?

Date Posted: 31 October 2006