South Dakota Gov. Mike Rounds (R) in a news conference on Tuesday distanced himself from a state law (HB 1215) that bans all abortions in the state except to save a pregnant woman’s life, saying he has no current plans to “actively campaign” in support of or opposition to the law if the issue goes before state voters in November, the Sioux Falls Argus Leader reports. “When people asked my opinion, I would share with them that my preference would be to take Roe v. Wade” — the 1973 Supreme Court decision barring state abortion bans — “apart piece by piece,” Rounds said. He added, “But other than that, … this is [the law’s supporters’] opportunity to find out, at least in the next few years, whether or not the Supreme Court would entertain this as the right vehicle to address abortion within the United States.” When asked about the law’s lack of an exception for cases involving rape or incest, Rounds replied, “I did not write this bill” (Woster, Sioux Falls Argus Leader, 3/8). He added that although the law does not allow abortion in cases of rape or incest, survivors still will have access to emergency contraceptives, which can prevent pregnancy if taken up to 72 hours after sexual intercourse (Brokaw, AP/Aberdeen American News, 3/7). Rounds said, “So if you do have an individual who has been victimized with rape or incest, there is a time period in which this bill does not apply to contraceptive drugs and so forth being utilized.” The law says EC can be administered until tests can determine whether a woman is pregnant, according to the Argus Leader. Rounds said that time period is about five to seven days (Sioux Falls Argus Leader, 3/8). White House Press Secretary Scott McClellan on Tuesday reiterated President Bush’s position on abortion rights, saying Bush is “pro-life with three exceptions: rape, incest and when the life of the mother is in danger.” McClellan called the law a “state matter” and added that the law “was passed by the South Dakota Legislature and signed into law by the governor of that state. … The president’s view when it comes to pro-life issues has been very clearly stated, and his actions speak very loudly, too” (AP/Dallas Morning News, 3/7).
“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . ?2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Time magazine in its March 13 issue examined Wal-Mart’s announcement that by March 20 it will begin to stock and fill prescriptions for Barr Laboratories’ emergency contraceptive Plan B — which can prevent pregnancy if taken up to 72 hours after sexual intercourse. Time called the action “the latest in a string of developments expanding access to [EC, and] one of the few arenas in which abortion-rights groups seem to be gaining ground.” According to Time, “[n]ow that Wal-Mart has agreed to stock [Plan B], so will every major pharmacy chain in the country.” FDA has delayed a decision on Barr’s application to provide nonprescription access to Plan B to girls and women ages 17 and older, and a decision seems “unlikely” before the November elections, Time reports. Therefore, some abortion-rights groups have focused efforts on expanding EC access at the state level, according to Time. Eight states allow pharmacists to dispense EC without a prescription if they are specially trained and follow specific guidelines, and seven states are considering similar legislation. Massachusetts and Illinois have requirements improving pharmacy access to EC, and Connecticut and New York are considering similar requirements. Some abortion-rights opponents are “deeply disappointed” in Wal-Mart’s “about face” on stocking Plan B, Time reports (Thottam, Time, 3/13).
“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . ?2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The Japanese government on Wednesday announced it will provide $3.8 million to UNICEF to improve Myanmar’s maternal and child health services, including efforts to combat HIV/AIDS and malaria, Xinhua News Agency reports (Xinhua News Agency, 11/9). UNICEF aims to use the funds to prevent vertical HIV transmission in the country by providing antiretroviral drugs to pregnant women. The organization also plans to purchase malaria drugs and 70,000 insecticide-treated nets for children and pregnant women. In addition, UNICEF plans to immunize more than 500,000 infants and women of childbearing age against measles and tetanus, respectively. “We need the support of the international community to help us protect Myanmar’s children from HIV/AIDS, malaria, measles and other killers of children,” Carroll Long, UNICEF’s Myanmar country representative, said (Dow Jones/Mainichi Daily News, 11/9). Earlier this year, the Global Fund To Fight AIDS, Tuberculosis and Malaria announced its withdrawl of funding to Myanmar — also known as Burma — citing travel and other restrictions implemented by the country’s military-controlled government that impede the delivery of medical supplies and services. The Global Fund in 2004 pledged to spend $98 million in the country over five years for programs to fight the three diseases (GlobalHealthReporting.org, 8/23).
Japanese Coalition Donates $250,000 to Global Fund
In related news, a Japanese coalition of anti-poverty organizations on Tuesday announced it is donating $250,000 to the Global Fund. The money consists of a portion of the proceeds made by the Hottokenai Sekai-no-Mazushisa campaign from the sale of white plastic bracelets in Japan. The white bracelets are a symbol of the global campaign to eradicate poverty and are modeled after similar bracelets from the Make Poverty History campaign in the United Kingdom and the ONE Campaign in the U.S. In June, Japan pledged an additional $500 million to the Global Fund to be disbursed over several years (Global Fund release, 11/8).
“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . ?2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Soft tissue and musculoskeletal infections are more common than respiratory tract infections among survivors of the tsunami.
Of an analysis of 30 patients who had been hospitalized, researchers at Samitivej Srinakarin Hospital, in Thailand, found 27 patients had soft tissue and musculoskeletal infections (90 percent), 10 people had respiratory tract infections (33 percent), 10 patients had polymicrobial Gram-negative infections, and 6 people had multiple sites of infection (20 percent).
The average hospital stay was 4 days. The most effective treatments for infectious complications related to submersion injuries from seawater are beta-lactam antibiotics or fluoroquinolones and removing foreign material via surgical debridement and endoscopy.
CHEST 2005 abstract highlights
Jennifer Stawarz
jstawarz@chestnet.org
American College of Chest Physicians
chestnet.org
Hundreds of thousands of people affected by the earthquake in Pakistan face the unnecessary risks of death, illness and further injury as winter approaches. People need shelter, safe drinking water and access to health care now and throughout the winter in order to survive.
The earthquake and aftershocks have killed over 53 000 people and injured an estimated 75 000, including many health staff. The latest available assessments show that 291 health facilities have been destroyed and 74 partially damaged of a total of 564 in the area. Less than half continue to operate.
The World Health Organization (WHO), with other health partners, is taking action and has already made a difference with the help of timely donations. Tens of thousands of people have had access to surgery, medicines, vaccination and other public health measures care.
To expand access to health care for the thousands who still need it now, to provide health care throughout the winter, and to prevent and respond to any outbreaks, WHO is appealing for a total of US$ 27.57 million, as part of the revised United Nations Appeal. So far, US$ 11 million has been pledged to WHO since 8 October.
“Without more help now, the second wave of deaths in Pakistan is coming. We cannot wait to see images of people freezing to death or dying of preventable disease before we act. With the money received so far, WHO, its partners and the Ministry of Health have made a difference to people’s lives. The revised appeal will scale-up WHO’s support,” said Dr Ala Alwan, WHO Representative of the Director-General for Health Action in Crises.
The revised appeal will increase WHO’s support to the Ministry of Health in tackling four vital areas of health.
Increased access to health care
To date, tens of thousands of people have received medical treatment at civil and military health facilities but many people with major medical and surgical needs in remote areas are still being found. People with complicated injuries will need follow-up care and people with chronic disease such as diabetes, heart and kidney disease need access to regular treatment.
WHO has already sent supplies and medicines to meet the healthcare needs of 270 000 people for one month. More medical and surgical supplies are in the pipeline.
Preventing disease and suffering
Poor water quality and lack of adequate sanitation has increased the risk of communicable diseases such as diarrhoeal illness and measles. To quickly spot outbreaks and prevent epidemics, WHO has supported the Ministry of Health to build a disease surveillance system involving over 200 medical experts and staff. The disease surveillance system will be expanded to all affected areas.
As a preventive measure WHO and UNICEF are supporting the Ministry of Health and other health partners in vaccination campaigns against tetanus and measles. Over 50 000 children have been vaccinated so far. More vaccines and other supplies are currently being made available.
Addressing mental health needs
Many of the 3.5 million people affected by the earthquake have experienced extreme loss - of their homes, family and livelihoods The fact that many bodies have not been and may never be recovered is also a source of mental distress.
Based on the experience of previous disasters, severe mental disorders (psychosis, severe depression, and anxiety disorders) may be seen in between 3-4% of the affected population. In the Pakistan earthquake situation this means 120 000-160 000 persons may need treatment for severe mental disorders. Up to 15% or 600 000 may be expected to suffer from mild and moderate mental disorders.
In response to the increased need for mental health and psychosocial support, WHO is working closely with the Ministry of Health and other partners to train mental health workers in providing psychological care to earthquake survivors. The Ministry of Health has already deployed four teams of specialists to the most affected areas.
Health coordination
WHO, through its network of national and expatriate staff in Islamabad and five field offices in Muzaffarabad, Mansehra, Balakot, Bagh and Rawalakot continues to support the Ministry of Health in coordinating with dozens of health actors already operating in the affected areas.
To help humanitarian actors better target their health interventions, WHO has created a website link www.whopak.org/disaster/ containing practical health information such as guidelines for best practices, lists medical supply needs and situation reports. WHO continues to answer health queries through an email address health@whopak.org and a hotline telephone service Tel: 92 51 250 5176 / 926 3240.
The revised WHO Appeal is part of the larger United Nations Consolidated Appeals Process (CAP): Flash Appeal 2005 for South Asia Earthquake seeking a total of US$ 549 585 941 for six months.
who.int
US Congress has wasted an opportunity to tackle the rising numbers of chronically hungry people in the world, states an editorial in this week’s issue of The Lancet.
On World Food Day, Oct 16, the World Food Programme (WFP) delivered some disquieting news: the number of chronically hungry people is rising again after decades of decline. Almost 6? million people have died so far this year from hunger and related diseases, which claim more lives than AIDS, malaria, and tuberculosis combined.
The USA funds just under 60% of all food aid. The Bush Administration wants to purchase 25% of its food aid abroad, rather than buying it in the USA and shipping it to where it is needed, as the current law requires. This policy would make food aid much more effective by cutting transportation costs, which currently swallow 40% of aid money, states the editorial. However, Senate leaders have voted against the Bush proposal, in a move widely viewed as an attempt to protect the interests of US farmers and cargo-ship firms who currently profit from government-donated aid.
The Lancet comments: “Congress has squandered valuable presidential will to address one of the world’s most persistent humanitarian issues匧ast week, the WFP called for a redoubling of efforts to fight hunger from all nations of the world. The stance adopted by US congressmen underlines that what is needed is not simply more food or aid, but a concerted international effort to eliminate domestic political constraints on aid sourcing and delivery.”
Joe Santangelo
j.santangelo@elsevier.com
Lancet
http://www.thelancet.com
A Johns Hopkins emergency physician who spent the past five weeks working on public health issues in the Gulf Coast region following hurricane Katrina warns that the disaster’s potential for wreaking havoc and damage to people’s health may continue for months after the hurricane has passed.
In an editorial published this month in The New England Journal of Medicine, Thomas Kirsch, M.D., M.P.H., an assistant professor and director of emergency operations at The Johns Hopkins University School of Medicine, reports that large numbers of displaced people are at increased risk of infectious diseases, such as chicken pox, gastroenteritis, scabies and influenza, which can spread quickly in disaster shelters. In these confined quarters, Kirsch says, crowded and poor sanitary conditions, including limited access to clean water and insufficient numbers of toilets, help spread disease from person to person.
However, Kirsch notes that people with chronic health conditions face the biggest threats by far, lacking immediate access to their routine medical services for hemodialysis, or access to medications for diabetes, heart disease, HIV or tuberculosis.
Kirsch, who went to the Gulf Coast area to conduct medical needs assessments for the American Red Cross, says constant monitoring and surveillance are required to contain disease outbreaks. More importantly, he adds, improving the current public health care system so that it is strong enough to prevent disease through mass vaccinations and large enough to survive a natural disaster is the best means of guarding population health.
David March
dmarch1@jhmi.edu
Johns Hopkins Medical Institutions
http://www.hopkinsmedicine.org
It is just after midnight, very early on a Thursday morning. One day before hurricane Wilma is expected to hit Cancun, where I am now.
For the last couple of days everyone in Cancun, and the state of Quintana Roo (where Cancun is) has been listening to radio and TV bulletins. On Tuesday morning Wilma was just a tropical storm. By the end of the day it had developed into a category 2 hurricane. During the night it became stronger. On Wednesday morning I woke up and checked on the internet to find the storm had progressed to a category 5.
Shall we stay here and sit it out or evacuate, move to some other part of the country? I kept the radio on for most of the day as news reports came in that Wilma was the most powerful hurricane ever recorded in this part of the world.
I looked out of my office window and saw people busily boarding up their windows, clearing stuff that could blow around, municipal workers taking down traffic lights and covering public telephones with plastic lining. Others were pruning the beautiful palm trees of branches that may blow away in the wind.
By about two o’clock in the afternoon (Wednesday), we decided it would be best to book a flight to some other part of the country. My wife, Maria, rushed out and came back a few hours later with tickets to Monterrey - a city in the north of Mexico, inland, about a 2 hour drive from the Texan border.
We have two boys, aged 18 and 12. The twelve year old was excited about having to miss school, but also concerned about what the Cancun may look like when we come back on Sunday. My oldest son, who is studying at a university here, is both worried and also in awe of what is to come. We moved to Cancun at the beginning of the summer of this year. We immediately fell in love with the place. It’s fauna and flora are fascinating - like living in a giant wildlife park.
We hope and pray that Wilma will spare the people of Cancun and find a path towards the sea.
The authorities in Mexico have moved swiftly. At this moment their aim is to get at least half of the 30,000 tourists (this is the low season) out of the country by this evening. The hurricane is expected to hit sometime during Friday morning. The airport is going to be chock-a-block full. We will be there in a few hours’ time. I expect there will be crowds, frustrations, tired staff and many frightened faces.
On the radio just now the mayor of Cancun said that anyone who has the means should seriously consider moving to some other part of the country before the storm hits. He is currently inspecting the many shelters the local authorities are setting up for people who can’t get out - and there are many of them. The city has grown rapidly over the last three decades - it now has over half a million people.
The bulletins on radio and TV come in two languages, Spanish and Mayan. Many people in Cancun speak Mayan. The messages range from: Make sure your flashlights are working, check you have enough batteries for flashlights and your radio, clear your yard (garden) of stuff that can be blown around, tape up your windows, ensure you have a good supply of purified water, remember to turn your gas mains off before the storm starts. To: check on your neighbours, listen to the radio bulletins, don’t hoard food - just buy enough for a couple of days.
Watching the peaceful efficiency of the local people as they prepare for an emergency has helped lessen my sense of anxiety. These people, the people of Quintana Roo, have lived with the threat of hurricanes all their lives.
We pray for them.
Written by: Christian Nordqvist
Editor: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Severely injured people continue to be airlifted to Islamabad for urgent treatment. According to the Ministry of Health, approximately 13 000 people have received surgical treatment so far. The Pakistan Institute for Medical Sciences (PIMS) continues to receive patients but the case load is lower than on previous days.
* To reduce the number of medical air evacuations to Islamabad, the Ministry of Health with support from WHO will establish a referral system between the existing health providers in Muzaffarabad. The Abbas Institute of Medical Sciences (AIMS) together with four field hospitals are able to cover the number of required surgeries. However, there is a shortage of bed space and resources for post-operative care. Also, many patients simply have nowhere to go after they have been treated.
* The district government of Punjab will be making 4000 additional hospital beds available for the treatment of earthquake victims.
Cold weather coupled with lack of shelter is a major health concern
* The onset of winter coupled with a lack of shelter is a serious health concern that needs to be resolved quickly to avoid health problems such as hypothermia, shock and death. Warm blankets and winterized tents are urgently needed. According to the latest situation report from the United Nations Office for the Coordination of Humanitarian Affairs, temporary shelter for about three million people is a priority requirement. Despite contributions (32 000 tents already delivered, 150 000 currently in the pipeline), thousands more tents are needed.
Risk of disease is still present
* Although no major outbreaks of disease have been identified, risk factors still exist. Access to safe water, adequate sanitation and nutritious food are a priority to keep people healthy and prevent disease. The provision of latrines and mobile water plants continues to be urgently required.
* The Ministry of Health with support from WHO has set up an Early Warning and Response Network (EWARN) to quickly identify and respond to outbreaks of disease. Surveillance officers have been trained and will train health staff in disease tracking and response. A further 200 public health specialists will be deployed to gather data from existing health centres. Surveillance will begin in Muzaffarabad and spread out to other reachable affected areas. The first report on the epidemiological status should be available by week’s end. All health partners are being asked to inform the Ministry of Health of any outbreaks of disease.
* The Ministry of Health and WHO continue to deliver large quantities of supplies to the affected areas with more than 50 vehicles currently transporting medicines, medical supplies and water and sanitation supplies from Islamabad to different locations.
* Medical and surgical teams increasingly report seriously infected wounds among the injured. There is a shortage of tetanus toxoid vaccine and anti-tetanus immunoglobulin.
* The Ministry of Health has vaccination teams operating in Muzaffarabad and all accessible areas in the district and are vaccinating children from 9 months to 12 years old against measles and providing Vitamin A supplements. Approximately 3000 children have been vaccinated. Vaccinations are also taking place from Peshawar to Mansehra.
Donations towards WHO appeal for Pakistan Earthquake
Total cash and in-kind donations is US $11,170,185 or (51.48%) of US $21.7 million appealed for.
– The Government of Australia US $1,899,696
– The Government of Canada US $1,483,050
– The Government of Denmark US $483,870
– The Government of Ireland US $120,192
– The Government of Italy US $300,481 (plus generous in-kind donations)
– The Government of Japan US $1,000,000
– The Government of Monaco US $120,192
– The Government of Norway US $250,000
– The Government of Sweden US $1,928,020
– The Government of Switzerland US $100,000
– The Government of the United Kingdom US $1,133,834
– The Government of the United States of America US $2,000,000
http://www.who.int
Thousands of people have started fleeing their remote and hard-to-reach villages in northern Pakistan and Pakistan-administered Kashmir, seeking medical attention, food and water, as landslides and bad weather continue to impede the delivery of desperately needed relief supplies, WFP has warned.
“WFP and other aid agencies are finally managing to reach more remote earthquake affected areas that were previously inaccessible because of landslides.
“At the same time, aid workers have today observed thousands of people descending from the mountains to seek assistance in the valleys,” said Michael Jones, WFP emergency coordinator in Pakistan.
Massive bulldozers
The Pakistani military are using massive bulldozers to clear road blockages to enable relief vehicles to get through to villages that have not received any aid since the earthquake that killed at least 40,000 people hit this area on 8 October.
“Large numbers of survivors are moving down mountain roads in search of help. We saw them today after we reached Kamsar in the Neelum Valley, an area that opened up last night for the first time,” said WFP aid worker Mia Turner, now in Kashmir.
“Nothing to eat in days”
“There are about 20,000 people here and we are distributing flour and high energy biscuits to them. They told us they have had little or nothing to eat in days.
“Thousands of people are walking down the mountains. Whole families are moving. They do not seem to have any tents or any other form of shelter, ” said Turner.
Buried in the mud
The WFP team in Kamsar said the route to the village had been blocked by a massive landslide. Crushed vehicles could be seen buried in the mud and under huge granite boulders.
On the way up the mountain, the team passed two villages that had been completely destroyed by the earthquake. The air around Kamsar is full of dust as landslides continue - caused by the frequent aftershocks.
Trucks, helicopters, mules
WFP food assistance to the region is being transported by truck where roads are open and by helicopter and pack mules in more remote mountain areas.
Aid agencies, however, are also preparing to move survivors who opted to descend to the valleys instead of waiting in inaccessible villages.
“The intention is that the displaced should be accommodated in temporary large tented camps,” Jones said.
Unknown numbers
However, many desperate people, among them unknown numbers of injured, still remain in the mountains, survivors said. It is estimated that there are up to 500,000 needy people whom no one has reached because of their remote locations, appalling weather conditions and landslides.
The UN Office for the Coordination of Humanitarian Affairs (OCHA) said the situation in the region had become dire, with a deep sense of challenge and desperation in the field, amid fears that the logistical challenges of the operation may be insurmountable.
It said many people were dying before help could reach them.
Shuttling foodstuffs
“We are moving up to fifty tons of foodstuffs a day and shuttling it into location as we get it,” said Jones.
“And we’re transporting the food supplies along with shelter, blankets and other necessities. WFP is bringing in extra trucks from the region and building up its airlift capacity.”
Pressing need for action
WFP is concerned about donors’ response to the earthquake which hit 11 days ago.
“We know our donors are generous, but there is a pressing need for swift action, otherwise more and more people will suffer and even die,” Jones warned.
wfp.org