Παρέμβαση του Επισκόπου Μπουκόμπας στην “Σπιναλόγκα” του AIDS στην Τανζανία

Φίλοι Ιεραποστολής Μπουκόμπα Τανζανίας

Στον Ορθόδοξο Αμπελώνα της Αφρικής

Σοβαρή παρέμβαση από την Επισκοπή Μπουκόμπας και Δυτικής Τανζανίας, έγινε στην “Σπιναλόγκα” του AIDS στην Τανζανία, στο παραλιακό χωριό Καλομπέρα της Μπουκόμπας, με αφορμή την Παγκόσμια Ημέρα κατά του AIDS.

Η προσπάθεια βοήθειας προς την κλειστή αυτή κοινότητα ξεκίνησε πριν δύο χρόνια, όταν οι αδελφές από το Μοναστήρι της Αγίας Μακρίνας (*) έκαναν ιεραποστολή και βαπτίσθηκαν 50 νέοι χριστιανοί. 

Πριν δύο μήνες ξεκίνησαν δύο Κατηχητές συστηματική κατήχηση και λειτουργικές συνάξεις, για την συγκέντρωση των βαπτισμένων και την προετοιμασία των νέων κατηχουμένων.

Κτίσθηκε πρόχειρος Ναός προς τιμήν του Αγίου Μηνά και η Ορθοδοξία μπήκε για τα καλά στην κοινότητα αυτή. Με αφορμή τον ερχομό των επισκεπτών από την Ελλάδα, σε συνεργασία με τον πρόεδρο του χωριού και μετά από άδεια από το Κράτος, την Πέμπτη 1 Δεκεμβρίου, ο Επίσκοπος Μπουκόμπας κ. Χρυσόστομος με γιατρούς και κατηχητές επισκέφθηκε την Καλομπέρα.

 

Οι ιθαγενείς αφού υποδέχθηκαν με πολύ χαρά τους επισκέπτες, συγκεντρώθηκαν στην πλατεία κοντά στη λίμνη Βικτώρια και παρακολούθησαν την ενημέρωση που έγινε για την μεγάλη απειλή του AIDS, τις αιτίες εξάπλωσης και τους τρόπους αντιμετώπισης. Η εκδήλωση ξεκίνησε με την υποδοχή από τον πρόεδρο του χωριού κ. Ησαΐα και τον εφημέριο π. Σπυρίδωνα.

Μίλησαν η κ. Βαρβάρα Κορωναίου, γιατρός από την Φλώρινα, και ο Διευθυντής του Νοσοκομείου της Επισκοπής “ΑΝΑΣΤΑΣΙΣ” κ. Ηλίας Habuhabu.

Τις ενημερωτικές ομιλίες έκλεισε ο Θεοφιλέστατος κ. Χρυσόστομος προτρέποντας τους κατοίκους να προσέλθουν στις δωρεάν εξετάσεις, που θα γίνονται από τους γιατρούς του Νοσοκομείου της Επισκοπής. 

Κάλεσε, ακόμη, τους κατοίκους να βάλουν ένα τέλος στους θανάτους από AIDS και να σταματήσουν την εξάπλωση της επιδημίας στην κοινότητά τους.

Η Ορθόδοξη Εκκλησία θα τους βοηθήσει αποτελεσματικά, όπως είπε ο Θεοφιλέστατος.

Η συνάντηση ολοκληρώθηκε με δώρα, τραγούδια και παιχνίδια για τα παιδιά από τους επισκέπτες από την Ελλάδα με επικεφαλής...

https://www.facebook.com/profile.php?id=100055952163170

 

(*) Πρόκειται για την Ιερά Μονή Αγίας Μακρίνας Κιμπούγιε, για την οποία διαβάζουμε στην ανάρτηση Το μοναστήρι της Αγίας Μακρίνας φροντίζει την «Σπιναλόγκα» της Τανζανίας:

... Αξίζει να σημειωθεί πως το Μοναστήρι της Αγίας Μακρίνας βρίσκεται πάνω από την «Σπιναλόγκα» της Τανζανίας, τρία χωριά τα οποία κατοικούνται αποκλειστικά από ασθενείς του AIDS, την φροντίδα και την μόρφωση των οποίων έχει αναλάβει Ιεραποστολικό κλιμάκιο της Επισκοπής, αποτελούμενο από ιατρούς και εκπαιδευτικούς.

Africa: Women and Children Will Pay For This Pandemic – Unless We Act...

allAfrica.com

By H.E. Kersti Kaljulaid, President of the Republic of Estonia; Rt Hon. Helen Clark, PMNCH Board Chair, former Prime Minister of New Zealand; H.E. Jorge Alcocer Varela, Secretary of Health of Mexico; and Hon. Graça Machel, PMNCH former Board Chair and Founder of the Graça Machel Trust
 

Wherever COVID-19 strikes, it magnifies unfairness and inequality. In every nation and every community touched by the virus, hard-won progress for women, newborns and young people is being reversed.

This is not the work of the disease itself, but of our reaction to it: resources for essential health care shrink, people fear using health services, and poverty and hunger grow. The problems are compounded by fragile health systems and lack of preparation. A recent study in the Lancet indicates that, in low- and middle-income countries, all these factors could kill more than a million children and thousands of mothers in the next six months.

In the past twenty years, keeping mothers and children alive has been one of the great public-health success stories. Child death rates have almost halved, and maternal death rates are down by over a third. Those gains are now being eroded as inequalities spread, running like fractures along the lines of age and sex, further fragmented by geography, income, disability and ethnicity.

Coronavirus and children: 'I can't hug my mum any more'

BBC

Parents who are Covid-19 frontline workers have had to adjust interaction with their own children.
The usual parental hugs and dining together have been put on hold in order to reduce and possible risk of transmission of the virus.
BBC What's New spoke to some of their children and this is what they said.
Producer: Agnes Penda
Edited by Anne Okumu

Covid - 19. Η Αφρική μόνη στο χείλος του γκρεμού

Fragil
Στον Ορθόδοξο Αμπελώνα της Αφρικής

Όσο ο υπόλοιπος πλανήτης ασχολείται τα δικά του προβλήματα, η Αφρική περιμένει την καταστροφή. Tο χειρότερο μπορεί ακόμα να αποφευχθεί και πράγματι η αφρικανική ήπειρος χρειάζεται βοήθεια από τη διεθνή κοινότητα.

Ακούγεται σαν αστείο. Στις αφίσες, σε σημειώσεις και στο Διαδίκτυο, εκατομμύρια Αφρικανοί καλούνται επί του παρόντος να τηρούν την απαγόρευση της κυκλοφορίας, να παραμένουν τουλάχιστον δύο μέτρα μακριά από τους συνανθρώπους τους και να πλένουν τα χέρια τους τουλάχιστον κάθε 20 λεπτά. Πολλοί διαβάζουν τα νέα στα στενά δρομάκια των παραγκουπόλεών τους ή στις μικρές καλύβες από λαμαρίνα, στις οποίες μένουν έξι ή οκτώ άτομα. Βλέπει κανείς τις αφίσες στο δρόμο προς τις λιγοστές βρύσες που βρίσκονται στις παραγκουπόλεις τους και μπροστά από τις οποίες πρέπει να σχηματίζουν οι άνθρωποι ουρά. Νομίζεις ότι είναι ένα αστείο. Κάποιοι το λένε δυνατά: Δεν έχει νόημα. Θα πεθάνουμε σαν μύγες.

Αυτές τις μέρες, η Αφρική μπορεί να παρακολουθεί τα συστήματα υγείας των χωρών που πάντα θεωρούνταν παράδεισοι να καταρρέουν σαν σε αργή κίνηση. Εκεί, στα εκβιομηχανισμένα κράτη, οι διεφθαρμένοι πρόεδροί τους ήταν ευτυχείς να νοσηλεύονται, αφού πρώτα κατέστρεψαν τα νοσοκομεία τους. Υπάρχουν ημέρες και εβδομάδες κατά τις οποίες εκατομμύρια Αφρικανοί έχουν χρόνο να σκεφτούν πόσο άσχημες θα μπορούσαν να είναι οι εξελίξεις. 

Ο ιολόγος Christian Drosten προειδοποιεί ότι σύντομα θα υπάρξουν “σκηνές στις φτωχότερες χώρες που δεν μπορούμε να φανταστούμε σήμερα”. Ο Bill Gates υπολογίζει μέχρι και δέκα εκατομμύρια θανάτους στην Αφρική. Περισσότερους από οπουδήποτε αλλού στη γη.

Ο υπόλοιπος κόσμος είναι απασχολημένος με τον εαυτό του για να πάρει όσο το δυνατόν περισσότερες μάσκες και αναπνευστήρες για τον δικό του πληθυσμό. Τίποτα δεν θα μείνει για την Αφρική. Μια χώρα όπως το Μαλάουι διαθέτει 30 κλίνες εντατικής θεραπείας για 18 εκατομμύρια άτομα. Δεν υπάρχει αρκετό περιθώριο για αλληλεγγύη, ιδιαιτέρως για την Αφρική, όπου άνθρωποι πεθαίνουν συνεχώς. Εάν προσθέσει κανείς και όσες ενισχύσεις έχει ήδη ανακοινώσει η γερμανική κυβέρνηση για τη Γερμανία, φτάνει τα 1,2 τρισεκατομμύρια ευρώ. Σύμφωνα με το Ομοσπονδιακό Υπουργείο Εξωτερικών, έχουν διατεθεί στον Παγκόσμιο Οργανισμό Υγείας μόνο πέντε εκατομμύρια ευρώ ως υποστήριξη για την Αφρική.
Η προσέγγιση του περιορισμού της δημόσιας ζωής θα μπορούσε ακόμη και να είναι αντιπαραγωγική στην Αφρική.

Είναι δύσκολο να σκεφτεί κανείς άλλους όταν χάνει τη γη κάτω από τα πόδια του. Αλλά η σκέψη με όρους κρατών και συνόρων δεν θα κάνει τον κόσμο υγιή μακροπρόθεσμα, επειδή τον ιό δεν θα τον σταματήσει κανένα σύνορο. Ούτε θα μείνει μόνο σε μια ήπειρο. Ο κόσμος θα επιστρέψει στο κανονικό μόνο αν ο κορονοϊός νικηθεί στην Αφρική.

Μέχρι στιγμής, οι περισσότερες κυβερνήσεις στην ήπειρο έχουν ενεργήσει με εντυπωσιακή συνέπεια και έχουν επιβάλει απαγορεύσεις κυκλοφορίας – σε μια εποχή που στην Κολωνία γινόταν πάρτι κορονοϊού με αποτέλεσμα σημαντικά περισσότερους μολυσμένους ανθρώπους. Σε πολλές χώρες της Αφρικής, ο Covid-19 θεωρείται μια ασθένεια των πλούσιων λευκών και της τοπικής ελίτ που έχουν τα χρήματα για να ταξιδέψουν και να συναντήσουν τον ιό. Και ποιος έχει επίσης τα μέσα για να νοσηλευτεί σε αυτές τις ακριβές ιδιωτικές κλινικές που διαθέτουν αναπνευστήρες. Συνεπώς, υπάρχει ελάχιστο κίνητρο για ορισμένους να αντιταχθούν στον ιό. Τίποτα δεν βοηθάει, λένε κάποιοι.

Αλλά για όλους τους άλλους, ισχύουν τα εξής: θέλουν να αποτρέψουν τη ραγδαία εξάπλωση του κορονοϊού στην Αφρική όπως προβλέπεται – αλλά δεν μπορούν. Το πάγωμα της δημόσιας ζωής έχει ήδη φτάσει στα όριά του στην Ευρώπη. Στην Αφρική, θα μπορούσε να είναι και αντιπαραγωγικό. Το κλείδωμα των ανθρώπων στις μεγάλες πόλεις σε ένα περιορισμένο χώρο διευκολύνει την πρόοδο του ιού. Ενώ πολλοί εργαζόμενοι στην Ευρώπη μπορούν άνετα να αποσυρθούν στα σπίτια τους ή να λάβουν κρατική ενίσχυση, εκατομμύρια Αφρικανοί είναι σε οριακή κατάσταση: κατά τη διάρκεια της ημέρας κερδίζουν ως έμποροι, κομμωτές, ξεναγοί και οδηγοί τα απολύτως απαραίτητα για να φάνε. Για αυτούς, η απόσταση είναι κάτι που πρέπει να είναι κανείς σε θέση να αντέξει οικονομικά.

Το χειρότερο μπορεί ακόμα να αποφευχθεί

Οι πλούσιες χώρες πρέπει να βοηθήσουν τις φτωχότερες να αποκτήσουν κάποιο είδος βασικού εισοδήματος. Οι περισσότερες αφρικανικές χώρες έχουν θεωρητικά ένα σύστημα κοινωνικής βοήθειας, αλλά όχι τα χρήματα. Άλλες κινδυνεύουν να χάσουν όλα, όσα έχουν κατακτήσει με ταχείς ρυθμούς τα τελευταία χρόνια, μια αυξανόμενη μεσαία τάξη, βιομηχανική παραγωγή και τουρισμό. 

Για πολλούς Αφρικανούς, η Ethiopian Airlines αποτελεί σύμβολο τού τι είναι δυνατό σε αυτή την ήπειρο, αν υπάρχει σχέδιο και ελάχιστη διαφθορά. Σε πολύ σύντομο χρονικό διάστημα, η αεροπορική εταιρεία έγινε η τέταρτη μεγαλύτερη στον κόσμο από την άποψη του αριθμού των διεθνών προορισμών που εξυπηρετούνται. Τώρα αντιμετωπίζει την καταστροφή και μαζί με αυτή και η οικονομία της Αιθιοπίας, η οποία εξαρτάται από το συνάλλαγμα της εταιρείας. Ερευνητές έχουν υπολογίσει ότι ποτέ άλλοτε δεν έφυγε τόσο μεγάλο κεφάλαιο τόσο γρήγορα από την ήπειρο.

Η διεθνής κοινότητα πρέπει τώρα να επιστρέψει μέρος αυτού του κεφαλαίου για να στηρίξει τα συστήματα υγείας των χωρών αυτών, πολλές από τις οποίες έχουν εμπειρία στην αντιμετώπιση επιδημιών αλλά ελάχιστα μέσα. Το χειρότερο μπορεί ακόμα να αποφευχθεί. Αν υπάρχει η βούληση, θα αποφασιστεί το τι μέλλον θα έχει η Αφρική, αλλά και ποιο θα είναι το ήθος της Δύσης.

What the Early Church Can Teach Us About the Coronavirus

 

March 12, 2020  |  Moses Y. Lee

the gospel coalition

Photo from here

The early church was no stranger to plagues, epidemics, and mass hysteria. In fact, according to both Christian and also non-Christian accounts, one of the main catalysts for the church’s explosive growth in its early years was how Christians navigated disease, suffering, and death. The church’s posture made such a strong impression on Roman society that even pagan Roman emperors complained to pagan priests about their declining numbers, telling them to step up their game. 
So what did Christians do differently that shook the Roman Empire? And what can the early church teach us in light of the coronavirus? 

Non-Christian Response to Epidemics

In AD 249 to 262, Western civilization was devastated by one of the deadliest pandemics in its history. Though the exact cause of the plague is uncertain, the city of Rome was said to have lost an estimated 5,000 people a day at the height of the outbreak. One eyewitness, Bishop Dionysius of Alexandria [image], wrote that although the plague did not discriminate between Christians and non-Christians, “Its full impact fell on [non-Christians].” Having noted the difference between Christian and non-Christian responses to the plague, he says of the non-Christians in Alexandria:

At the first onset of the disease, they pushed the sufferers away and fled from their dearest, throwing them into the roads before they were dead and treating unburied corpses as dirt, hoping thereby to avert the spread and contagion of the fatal disease; but do what they might, they found it difficult to escape.

Non-Christian accounts confirm this sentiment. A century later, the emperor Julian attempted to curb the growth of Christianity after the plague by leading a campaign to establish pagan charities that mirrored the work of Christians in his realm. In an AD 362 letter, Julian complained that the Hellenists needed to match the Christians in virtue, blaming the recent growth of Christianity on their

“benevolence to strangers, their care for the graves of the dead, and the pretended holiness of their lives.” 

Elsewhere he wrote, 

“For it is a disgrace that . . . the impious Galilaeans [Christians] support not only their own poor but ours as well.” 

Though Julian questioned the motives of Christians, his embarrassment over Hellenic charities confirms pagan efforts fell massively short of Christian standards of serving the sick and poor, especially during epidemics. According to Rodney Stark in The Rise of Christianity, this is because “for all that [Julian] urged pagan priests to match these Christian practices, there was little or no response because there were no doctrinal bases or traditional practices for them to build upon.”

Christian Response to Epidemics

If the non-Christian response to the plague was characterized by self-protection, self-preservation, and avoiding the sick at all costs, the Christian response was the opposite. According to Dionysius, the plague served as a “schooling and testing” for Christians. In a detailed description of how Christians responded to the plague in Alexandria, he writes of how “the best” among them honorably served the sick until they themselves caught the disease and died:

Most of our brother-Christians showed unbounded love and loyalty, never sparing themselves and thinking only of one another. Heedless of the danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy; for they were infected by others with the disease, drawing on themselves the sickness of their neighbours and cheerfully accepting their pains.

Similarly, in Pontius’s biography of Cyprian, the bishop of Carthage [icon], he writes of how the bishop reminded believers to serve not only fellow Christians but also non-Christians during the plague:

There is nothing remarkable in cherishing merely our own people with the due attentions of love, but that one might become perfect who should do something more than heathen men or publicans, one who, overcoming evil with good, and practicing a merciful kindness like that of God, should love his enemies as well. . . . Thus the good was done to all men, not merely to the household of faith.

The impact of this service was twofold: (1) Christian sacrifice for their fellow believers stunned the unbelieving world as they witnessed communal love like they’d never seen (John 13:35), and (2) Christian sacrifice for non-Christians resulted in the early church experiencing exponential growth as non-Christian survivors, who benefited from the care of their Christian neighbors, converted to the faith en masse. 

Christian Response to Coronavirus

As we continue to wrestle with how to respond to the coronavirus, notice how non-Christians in the Roman Empire emphasized self preservation while the early church emphasized fearless, sacrificial service. Whereas non-Christians fled from epidemics and abandoned their sick loved ones as they feared the unknown, Christians marched into epidemics and served both Christians and also non-Christians, seeing their own suffering as an opportunity to spread the gospel and model Christlike love.

If the non-Christian response to the plague was characterized by self-protection, self-preservation, and avoiding the sick at all costs, the Christian response was the opposite.

How might we put that posture into practice in the face of COVID-19, setting ourselves apart from the world in how we respond to the growing epidemic? Perhaps we begin by resisting the fear that is leading to panic in various sectors of society—instead modeling peace and calm in the midst of rising anxiety all around us. Perhaps we choose to patronize local Asian American restaurants and businesses that other Americans are avoiding due to fear-based stereotyping. We might also seek to sacrificially serve our neighbors by prudently abiding by the advice of medical professionals to help slow the spread of the disease. Instead of just our own health we should prioritize the health of the wider community, especially the most vulnerable citizens, by exercising an abundance of caution without perpetuating fear, hysteria, or misinformation. This might mean costs for us—canceling travel or planned events, or even self-quarantine if we think we’ve been exposed—but we should accept these costs with joy.
“Other people would not think this a time for festival,” Dionysius said of the epidemic of his day. “[But] far from being a time of distress, it is a time of unimaginable joy.” To be clear, Dionysius was not celebrating the death and suffering that accompany epidemics. Rather, he was rejoicing in the opportunity such circumstances present for testing our faith––to go out of our way to love and serve our neighbors, spreading gospel hope, in both word and deed, in times of great fear. 

Notes of our blog

This article has been republished from a protestant blog. About Protestantism you can see the posts:

Memory Eternal, Fr. Peter Gillquist...
Matthew Gallatin: Thirsting for God in a Land of Shallow Wells 

 

The Early Church is the Orthodox Church. You can see:

Ancient Christian faith (Orthodox Church) in Africa

St. Simon of Cyrene & Black History Month

Orthodox Mission in Tropical Africa (& the Decolonization of Africa) 

African Initiated Churches in Search of Orthodoxy...
How “White” is the Orthodox Church?  

Why has coronavirus largely spared Africa?

The continent was much better prepared than many thought
 

January 2019 at Beni in DRC Congo, the frontline of the fight against Ebola. 

Photo: The World Bank / flickr

mercatornet.com

When it became clear that the novel coronavirus coming out of China was destined to be a pandemic, international concern quickly zeroed in on how countries with weak health systems, most of which are in Africa, would be affected. It was feared that they would be quickly overwhelmed by the virus and left reeling.
The continent’s exposure to China, occasioned by its deep commercial ties with the country, was the main source of concern, as shown by a brilliant modelling study analysing this risk, which came out on The Lancet. The World Health Organization and other international health agencies scrambled to provide technical assistance, and helped procure test kits and laboratory trainings for various African countries.
I do not discount the concern, and I appreciate the effort that was put into making sure African countries had a fighting chance. In fact, the apprehension was not limited to international quarters. Locally, many were worried that our governments were taking this too lightly. Even I took pot-shots at the Kenyan government for its apparent laxity.
The only problem is that the virus has largely spared Africa so far. It is true that several countries, from Egypt to South Africa, have recorded cases, and more are cropping up each day. Egypt seems to be having the roughest time of it, with a Nile cruise ship at the centre of a recent spike in cases. But much of the rest of the continent still has no cases.
This curiously low incidence rate has left many puzzled. Of the more than 100,000 cases worldwide, only a handful are in Africa, and more than half of those are in Egypt. Initially, it was feared that the disease might have already landed on the continent, unflagged by faulty detection mechanisms, and was festering, ready to burst forth when it was beyond control.
It is possible that this is the case, but the fear still hasn’t panned out. Instead, it is starting to emerge that in the midst of all the hand-wringing over how Africa would fare, some crucial information was overlooked. I have been able to identify two particularly important ones. In tandem, they may have placed a crucial role in shielding Africa from this outbreak.
The first is that Africa is not as exposed to China as many initially thought. China’s ties with Africa, though deep and significant for the continent, do not measure up to its relations with North America and Europe. It may be the biggest trading partner of many African countries but, in absolute terms, this is dwarfed by its trade with the rest of the world.
The case may be made that more Chinese travel to Europe and North America each year than have ever come to Africa. Chinese travellers made a total of 130 million foreign trips in 2017. Of these, only about 0.8 million (0.62%) were to Africa, and the total number of Chinese on the continent is estimated at about 2 million. In short, the rest of the world is way more exposed than Africa to China.
That study in The Lancet that I referred to earlier actually compared these different exposure levels, but it is deep inside the discussion section. For a real-life illustration, one need only look at the infection pattern of the virus. For most of its brief history, it has behaved as if Africa didn’t exist. And when it finally showed up, it came from everywhere except China. In fact, most cases so far have been of European origin, with a few cases originating elsewhere.
The second overlooked factor is that African countries might have the widest field experience in tackling outbreaks of viral diseases. From Ebola to Lasso fever to Zika, African countries have dealt with multiple outbreaks in recent memory. Thanks to this, they have developed extensive experience and capacity. Even the main drug being trialled for the new virus, remdesivir, has already been put  through its paces in African Ebola hotspots.
This experience has come in handy. For instance, the first coronavirus case in Sub-Saharan Africa was recorded in Nigeria, a country that eradicated Ebola in just three months during the 2013-2016 West African outbreak, and was already handling an outbreak of Lasso fever, a deadlier viral disease, when Covid-19 broke. The patient, an Italian, was put in quarantine, and all traceable contacts were isolated. One of them is now Nigeria’s second confirmed case.
While reporters note [tweet and article] that they could still enter the US without being screened, African countries (including the small, relatively un-exposed ones) have become fortresses against the virus. All entry points, for all they are worth, are heavily monitored, with masked officials taking temperatures and flagging suspicious cases.
From the outset, many countries already had the infrastructure in place for this exercise. I can personally attest to it; while re-entering Kenya from Uganda back in December 2019, I was screened for Ebola. Since the primary screening method for both viruses, taking temperatures at entry points, is the same, all that was needed was to beef up the operation, rather than starting from scratch.
This level of unwitting preparedness, combined with our lower exposure to China, is possibly the main reason Africa’s coronavirus incidence rates have remained low for so long. Thanks to it, our governments have had more time than the rest of the world to build specific capacity to tackle the new virus. I may yet be proven wrong, but it seems our fragile health systems were better prepared than those of most advanced countries.
Just to underscore this, on March 3, the last Ebola patient left the treatment centre in Beni, the scene of the latest outbreak of the disease in the Democratic Republic of the Congo. It took over a year to stamp out the outbreak, and the victory was celebrated with song and dance. But the world didn’t notice, because everyone was freaking out about the new virus.
On March 10, the DRC recorded its first Covid-19 case. The world had better watch how the country handles this new challenge. There might be a thing or two to be learnt.

Note: It should be obvious, but this is an article about a fast-moving story, so things may have changed by the time you read it.

Also, I am not an expert in disease management. My treatment of this issue is entirely from a layman’s perspective.

Mathew Otieno writes from Nairobi, Kenya.

See also
Coronavirus (COVID-19) in Africa

Στα παρασκήνια των εξωτικών πακέτων διακοπών!

Ιεραποστολή στην Επισκοπή Τολιάρας και Νοτίου Μαδαγασκάρης

ΠΡΟΣΚΥΝΗΤΗΣ
 

Πολυήμερα πακέτα διακοπών σε εξωτικούς προορισμούς, φωτογραφίες τουλάχιστον ελκυστικές, παραλίες με χρυσή άμμο και σμαραγδένια νερά, ξενοδοχεία ως τσιμέντινοι επίγειοι παράδεισοι, καλάθια γεμάτα τροπικά φρούτα τοποθετημένα αριστοτεχνικά πάνω σε κεφάλια ιθαγενών οι οποίοι χαμογελούν πλατιά στην κάμερα του φωτογράφου.

Το γύρισμα τελείωσε για σήμερα, η διαφήμιση θα προσελκύσει ορδές τουριστών οι οποίοι επιθυμούν να γλυτώσουν από την πλήξη του γραφείου τους, από την βαρετή οδήγηση, από τις ξεθωριασμένες ζωές τους. Τα φώτα του ξενοδοχείου κλείνουν η παραλία αδειάζει, το καλάθι με τα φρούτα μοιράζετε στο συνεργείο, οι μπανάνες καταναλώνονται άμεσα, λόγω του εύκολου ξεφλουδίσματος τους, και υπόλοιπα φρούτα μετά από λίγες δαγκωνιές επιστρέφουν στο καλάθι.
Ο εργαζόμενος ιθαγενής επιτέλους μπορεί να αφήσει το καλάθι στο τραπέζι ξεκουράζοντας τον αυχένα του, ο οποίος από το βάρος ετών δουλειάς έχει στραπατσαριστεί. Κοιτάζει δεξιά αριστερά και αρπάζει γρήγορα δύο τρία κοκκινωπά φρούτα που έχουν τις λιγότερες δαγκωνιές. Πλέον μπορεί να σβήσει το χαμόγελο. Να βγάλει αυτή την φρικτή μάσκα χαράς η οποία είναι το αντίτιμο για το μεροκάματο. Πολλές φορές νιώθει ότι ο αυχένας του είναι λιγότερο στραπατσαρισμένος από την ίδια του την ψυχή.

Μπαίνει στο σχεδόν αρχαίο λεωφορείο, αυτό που και όταν ήταν παιδί έμοιαζε ήδη παλιό. Στο χέρι του κουδουνίζουν τα κέρματα από το μεροκάματο του. Πάρα κάτι ενάμιση ευρώ. Απότομο φρενάρισμα. Άνοιγμα της πόρτας, σπρώξιμο και ανηφόρα για την πόρτα του νοσοκομείου. Ο μικρός του τον περιμένει. Με τις χθεσινές οικονομίες και το σημερινό μεροκάματο μπορεί να εξασφαλίσει αντιπυρετικό για δύο μέρες και μια δεύτερη κουβέρτα, υποκατάστατο του στρώματος που είναι απλησίαστα ακριβό. Στο διπλανό κρεβάτι υπάρχει μια κυρία η οποία προτίμησε να νοικιάσει τη λάμπα ούτως ώστε να διαβάζει την Αγιά Γραφή παρά να πάρει στρώμα. Έτσι το φως φτάνει μέχρι τον μικρό ο οποίος παίζει με ένα καπάκι μπουκαλιού, κάνοντας ότι είναι μηχανάκι στη λεωφόρο του διάφανου σωλήνα του ορού του. Δύο φορές μέχρι τώρα έβγαλε τον φλεβοκαθετήρα γεμίζοντας το πάτωμα αίμα. Όταν ο πατέρας του του φώναξε, διότι έπρεπε να πληρώσει την αλλαγή, τότε ο μικρός είπε ότι φρέναρε απότομα.


 

2 όροφοι με τα πόδια, περπάτημα στο διάδρομο, που "ευωδιάζει" από τις αυτοσχέδιες λεκάνες με τα σωματικά υγρά που λιμνάζουν, και βρίσκεται μπροστά στην διάτρητη πόρτα του θαλάμου. Τόσες τρύπες στα τζάμια! Προχθές σκέφτηκε ότι της δημιούργησαν ψυχές που βγήκαν με μεγάλη ταχύτητα μη αντέχοντας άλλο την κόλαση.

Όταν είδε τη φιγούρα του πατέρα στο τζάμι ο μικρός "πάρκαρε" γρήγορα το καπάκι κάτω από το αυτοσχέδιο μαξιλάρι. Ο πατέρας μπήκε δίχως κουράγιο να χαμογελάσει. Κρατούσε στα χέρια του τα αντιπυρετικά και τρία κοκκινωπά φρούτα. Τα άφησε στο τραπέζι δίπλα στο σκουριασμένο κρεβάτι. Κάθησε αμίλητος. Κοίταζε τις σταγόνες του ορού. Μια, δύο, τρεις... Σκέφτηκε πόσα μεροκάματα τρέχουν μεσα εκεί. Πόσα φιλοδώρημα θα του χρειαστούν για να βγει ο μικρός από εκεί, πόσα χαμόγελα πρέπει να φορέσει, πόσα δαγκωμενα φρούτα να κλέψει, πόσα "Γιες μαντάμ" πρέπει να πει. Τουλάχιστον εξαγόρασε το σήμερα.

Βαθιά ανάσα και ανασκαφή στην τσέπη του. Μετά από λίγο βγάζει αυτό που έψαχνε και το δίνει στο μικρό. Από σήμερα θα τρέχει με δύο μηχανές στη λεωφόρο του ορού. Και η μάρκα της δεύτερης "evian".

Ορθόδοξη Εκκλησία στη Μαδαγασκάρη (Orthodox Church in Madagascar)

Και εδώ

Ο Χριστός στην Αφρική

Ιεραποστολή στην Επισκοπή Τολιάρας και Νοτίου Μαδαγασκάρης

Τρίτος Κόσμος

Ο σκηνοθέτης Παύλος Τριποδάκης για την Αφρική, την Ιεραποστολή, τα παιδιά και τον πόλεμο 

 

Ending AIDS as a public health threat by 2030: Scientific Developments from the 2016 INTEREST Conference in Yaoundé, Cameroon

www.ncbi.nlm.nih.gov

Abstract

The underpinning theme of the 2016 INTEREST Conference held in Yaoundé, Cameroon, 3–6 May 2016 was ending AIDS as a public health threat by 2030. Focused primarily on HIV treatment, pathogenesis and prevention research in resource-limited settings, the conference attracted 369 active delegates from 34 countries, of which 22 were in Africa. Presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens, were accompanied by oral, mini-oral and poster presentations. Spirited plenary debates on the UNAIDS 90-90-90 treatment cascade goal and on antiretroviral pre-exposure prophylaxis took place. Joep Lange career guidance sessions and grantspersonship sessions attracted early career researchers. At the closing ceremony, the Yaoundé Declaration called on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030.

 

Introduction

The goal to end AIDS as a public health threat by 2030 [1] was the underpinning theme of the 10th International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-Limited Settings (2016 INTEREST Conference) held in Yaoundé, Cameroon, 3–6 May 2016. The meeting attracted 369 active delegates from 34 countries of which 22 were in Africa (Cameroon, South Africa, Nigeria, Cote D’Ivoire, Kenya, Uganda, Zambia, Zimbabwe, Botswana, Ghana, Senegal, Tanzania, Benin, Burkina Faso, Congo, Gabon, Guinea, Liberia, Malawi, Namibia, Rwanda and Swaziland). Spirited plenary debates on the UNAIDS 90-90-90 (90-90-90 refers to the targets of 90% of people living with HIV knowing their serostatus, 90% of those who know they are HIV-positive being on antiretroviral treatment [ART] and 90% of those on ART achieving viral suppression. This translates into 73% of all people living with HIV being virally suppressed) treatment cascade goal for 2020 [2] and on antiretroviral pre-exposure prophylaxis (PrEP) took place. There were presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens [3].

In addition to oral, mini-oral and poster presentations, early morning Joep Lange research career guidance sessions saw mid-career and senior investigators explain how they got started on a research career and give advice on how to get funded, choose a mentor and get published. Parallel research grantspersonship sessions were presented by ANRS (France Recherche Nord & Sud Sidahepatites); Fogarty International Center, US National Institutes of Health; and EDCTP (European & Developing Countries Clinical Trials Partnership).

 

HIV in Cameroon

Cameroon’s Minister of Public Health, André Mama Fouda, opened the conference. Dr JB Elat, Permanent Secretary of the National AIDS Programme, presented an overview of HIV in Cameroon. HIV prevalence in 2011 was 4.3%, with urban populations and women disproportionately affected: 5.6% of women versus 2.9% of men. Compared to the general population, men who have sex with men (MSM) have 8–14× higher (24–44%), truck drivers have 5× higher (16%) and female sex workers (FSW) have 6× higher (36%) HIV prevalence. Clients of FSW account for 36% of new HIV infections annually. After Cameroon’s ART programme began in 2000, HIV prevalence fell by 20% between 2004 and 2011 from 5.5% to 4.3%. Prenatal consultations for prevention of mother-to-child transmission (PMTCT) increased steadily from 2009, with attendance reaching 74% in 2015. Between 2005 and 2015, the number of people on ART increased 10-fold and approximately 7,000 children now receive ART. In 2015, 882,639 Cameroonians were tested for HIV. Cameroon aims to increase access to HIV testing and treatment services, reduce stigma, strengthen supply chains, tailor HIV prevention for key populations and build civil society capacity. Poor retention in care remains a weak link in Cameroon’s progress towards 90-90-90 [4].

 

Achieving 90-90-90

Passionate debate presenting opposing viewpoints on 90-90-90 saw pessimists emphasize factors preventing achievement of the Fast-Track Initiative targets: insufficient resources (human, infrastructure, financial), inability to reach all people living with HIV (PLHIV) and retain them in care, risk of emerging drug resistance and international donor fatigue. Optimists highlighted the 17 million PLHIV on ART globally, opportunities to halt the HIV epidemic now and examples of countries close to achieving 73% viral suppression targets. Although achieving 90-90-90 is judged desirable, during the debate more conference participants became convinced the proposed time frame is too short.

The first 90: HIV testing

More than 150 million HIV tests are conducted in low- and middle-income countries annually and although the goal of diagnosing 90% of PLHIV is achievable, testing must be performed with 100% accuracy because of the profound consequences of misdiagnosis at both the individual and population level [5]. Outreach programmes are necessary for marginalized, stigmatized, often criminalized and hard to reach key populations. Community-based testing can reach healthy people early in their infection and link them to care [6]. Identifying all HIV+ children and adolescents requires case-finding approaches for chronic HIV survivors, intensified facility-based testing and decentralized and simplified HIV testing at point of care [7].

The second 90: ART

The World Health Organization recommends ART be offered immediately to everyone diagnosed with HIV infection, regardless of their CD4⁺ T-cell count measuring immune status [8]. Globally, 17 million people (46% of PLHIV) are on ART [9]. Voluntary licensing is enabling generic companies to provide antiretroviral (ARV) drugs in effective, well tolerated, and quality-assured individual or combination formulations for 100–130 USD per year. Voluntary licensing of drugs such as dolutegravir and tenofovir alafenamide may reduce this cost to 60 USD/year; however, more efficacy and safety data in pregnant women and HIV–TB-coinfected patients are needed [10]. Robust supply chains are essential to prevent stock-outs and ensure continuity of ART. Fulfilling high-income countries’ commitment to spend 0.7% of gross national income on overseas development assistance [11] can assist resource-limited countries but increasing domestic health-care funding in sub-Saharan Africa to reach the Abuja target of 15% of annual government expenditures being devoted to health will reduce donor dependency and facilitate sustainable programmes [12]. Building on the global success of generic ART, generic versions of drugs for tuberculosis, cancer and hepatitis B and C could facilitate drug access for people in resource-limited settings around the world at very affordable prices.

The third 90: viral suppression

Tracking viral suppression requires rapid scale-up of viral load monitoring, necessitating improved efficiencies in sample collection, transportation and laboratory performance; timely transmission of results to clinics and patients; and rapid appropriate action [13]. Treatment retention in Africa at 36 months is estimated at only 65% [14]. Poor adherence leads to drug resistance [15], requiring effective interventions, including mHealth and group delivery, to support retention in care and adherence. Innovations must be anchored in a comprehensive understanding of the multiple barriers facing people on ART, including adolescents who have important retention and adherence challenges.

The WHO recommends that ART scale-up be accompanied by high-quality HIV drug resistance surveillance, achieved by investing in human and laboratory resources, innovative and efficient technical approaches, robust supply chains and quality assurance measures. Political and community commitment is needed to overcome limited laboratory capacity in sub-Saharan Africa and support studies identifying suitable ARV options. These include the ultra-deep pyrosequencing work showing that protease inhibitors and mara-viroc are likely to be effective in young Cameroonian children (the author of this abstract received the Joep Lange award for the top-scoring abstract by an African scientist at the 10th INTEREST Conference) [16], as are protease inhibitors in Ugandan children [17].

 

HIV prevention

More than 10 million voluntary medical male circumcisions (VMMC) have been performed, with high adult MC prevalence countries moving to establish sustainable VMMC HIV prevention programmes focused on early infant and early adolescent MC [18].

PrEP with ARV drugs has achieved regulatory approval in South Africa and Kenya, following WHO guidance recommending PrEP when HIV incidence is 3% or more [8]. Follow-on studies and demonstration projects of oral PrEP among serodiscordant couples and MSM have shown higher adherence than in trial settings, possibly because people know that they are taking an effective product [19]. Novel products and delivery options under investigation include injectables that would be taken every 2 to 3 months, vaginal gel and ring formulations, and monoclonal antibodies. PrEP works for anyone experiencing a high risk of HIV exposure during a specific time of his or her life. A debate on whether Africa was ready for PrEP persuaded some who were sure it was ready to wonder whether regulatory, logistical, equity and other issues had all been adequately addressed. Importantly, PrEP implementation requires intensified investment in HIV testing strategies across Africa, which would result in the increased knowledge of serostatus that can improve entry into the 90-90-90 treatment cascade.

 

Vaccine and cure

The search for a vaccine, following the promising results of RV 144 [20], includes active and passive approaches to HIV prevention. Clade-specific trials in South Africa and elsewhere are part of the pox-protein public-private partnership (P5) evaluating pox-protein candidates. Hypothesis-generating Phase IIb trials are underway of passive immunisation strategies involving monoclonal antibodies using trivalent and tetravalent vectors to obtain broader coverage against HIV [21]. Research to understand differences in viral reservoirs with implications for cure strategies has found that Ugandans without HIV infection have increased immune activation and lymph node pathology that resembles early HIV infection among patients in Minnesota, USA [22]. If they acquire HIV in an environment where life-long exposure to various pathogens already predisposes them to high levels of T-cell activation, they may develop a larger HIV reservoir leading to persistent immune activation, subsequent lymph node fibrosis and reduced immune reconstitution. Pre-existing T-cell activation thus may account for population differences in responsiveness to immune therapy strategies, with fibrosis limiting diffusion of therapeutic agents into lymph nodes where the virus replicates.

 

Key populations

Success in bringing down HIV prevalence among sex workers in Rwanda, Burkina Faso, Kenya and Namibia highlights data gaps on successful interventions among men involved in sex work, regular partners of female sex workers and girls under 18 years who receive money or goods in exchange for sexual services. Exciting new developments include studies of PrEP use, integration of HIV and sexual and reproductive health services, and use of mobile technology, social media and biometric measures to assist in studying mobile sex work populations. Striking data on the use of heroin, tramadol and other opioids have led to the African Union Plan of Action on Drug Control that recognizes the burden of HIV and hepatitis C among people who inject drugs in Africa. Political barriers to holistic harm reduction remain for illicit drugs and for alcohol, a psychoactive substance with dependence-producing properties that has been strongly linked to HIV risk in Africa and around the world [23]. MSM have high HIV risks and continue to be criminalized in many African countries, making it difficult to reach them with services. In eight African countries, between 25 and 65% of these men aged 18–19 years are meeting male sexual partners online [24], suggesting that social media and mobile platforms could help increase their access to HIV prevention and treatment.

 

Emerging pathogens – lessons learned for and from HIV

The Ebola epidemic of 2014–2015 and epidemics of re-emerging pathogens, such as Zika and Lassa Fever, have shown that high-quality studies can run alongside the outbreak response, but health-care systems must be strengthened now before more epidemics occur. Designing and running Ebola clinical trials proved challenging in Guinea, Liberia and Sierra Leone. In Guinea, a ‘ring vaccination’ trial design was used to evaluate a vaccine candidate, with real-time modifications to take account of the rapidly changing epidemic and logistical issues [25]. The impact of favipiravir on Ebola virus disease was evaluated in a single arm, proof-of-concept trial that found it well-tolerated but could not draw firm conclusions about efficacy [26]. Ideally, outbreaks of emerging and re-emerging pathogens should be anticipated and potential drugs and vaccines for them investigated on an ongoing basis so that efficacy trials can be initiated quickly when an outbreak occurs. Engaging stakeholders, including community stakeholders, at all stages of a clinical trial contributes to robust trial design, facilitates trial conduct by addressing rumours and enhancing participant retention, and helps ensure ownership of the results for action [27]. Addressing ethical issues is key to ensuring that studies are conducted ethically, communities support them and post-trial legacies are assured [28]. Robust public health infrastructure, appropriate legislation and community involvement were key in containing an Ebola outbreak of 20 cases in Nigeria and subsequent health-care system investments have upgraded disease surveillance, research infrastructure and treatment facilities [29].

 

Conclusions

Although ART coverage in sub-Saharan Africa increased from 24% in 2010 to 54% in 2015, reaching a regional total of 10.3 million people [9], late diagnosis of HIV infection, loss to follow-up and poor ART adherence contributed to 790,000 people dying of AIDS-related causes in 2014. New adult HIV infections remain a concern: 25% are adolescent girls and young women and more than 20% are from key populations. An estimated 25.5 million people are living with HIV in sub-Saharan Africa, with women accounting for 56% [9]. There has been a 48% decline in new HIV infections among children in the 21 Global Plan priority countries [30], but 190,000 African children acquired HIV infection in 2014 [31].

The 10th INTEREST Conference heard a call for leadership and activism among HIV investigators and physicians to show global solidarity with PLHIV worldwide and to ensure that resources are used effectively. Sub-Saharan Africa loses over 150 billion USD/year through illicit financial flows [32], corruption and money laundering [12]. This money could replace international donations and fund health care throughout the continent. At the closing ceremony, the Yaoundé Declaration [33] (Additional file 1) was read out, calling on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030 [34,35].

 

Acknowledgments

The authors thank Wendy Smith (Wordsmiths International Ltd, Wells, UK) for providing meeting notes that were used as background materials for writing the manuscript. The INTEREST 2016 organizers acknowledge the support of the Ministry of Public Health, Cameroon; the National Institutes of Health and the Fogarty International Center, USA; the ANRS (France Recherche Nord & Sud Sidahepatites); and the following companies: Gilead Sciences, Janssen Pharmaceuticals, AbbVie, ViiV Healthcare, Roche and Mylan. 

See also

The History of AIDS in Africa
AIDS (tag in our blog)

 

Footnotes

Additional file

Additional file 1: The Yaoundé Declaration can be found at https://www.intmedpress.com/uploads/documents/3939_Hankins_Addfile1.pdf

Disclosure statement

All 12 authors reviewed previous drafts of the manuscript and approve its contents. None of the authors have a conflict of interest, with the exception of CABB of the company Virology Education that provided logistical support for the conference. 

 

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