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Tanzania, 16th Nov - 22nd Nov 2008
I got an opportunity to participate with four other Parliamentarians and EPF’s (European Parliamentary Forum) adorable workers in a study tour that focused on anti-malarial work. During the visit, we got to know Tanzania’s living conditions as well as malaria prevention and treatment programs. Malaria does not know state borders: there have been several severe cases of malaria in Finland too. Over 41 % of the world population is at risk of contracting malaria and the ongoing climate change is increasing the risk all the time. The people at risk are especially pregnant women and under five-year-old children but also Finnish tourists Malaria causes a severe socio-economic burden in Africa. Malaria slows down economic development and increases difficulties of the people suffering from poverty. There are almost 39 million people in Tanzania and the country is one of the poorest in the world since over 58 % of the people live on less than a dollar per day. In 2006 it was estimated that approximately 16 million malaria cases occurs every year causing over 80 000 deaths. Economic losses are around 3,4 % of GDP every year. Therefore the consequences of malaria are widespread and the impact of malaria prevention is significant for the future of the whole Sun 11th Nov 2008 It took a day and a night to travel from Helsinki to Dar es Salaam, Tanzania. During the
flight, butterflies were flying in my stomach and different kinds of thoughts were spinning in my head. What am I going to see and experience during this week? Mon 17th Nov 2008 We started the day by visiting the Research and Education Centre of Bagamoyo where
research on vaccinations is conducted in their own laboratory and health care and counseling bureau services are provided. Inside there were numerous small children with their mothers while men were waiting for their families outside in the yard. The families moved from place to place by mopeds and no one seemed to have any rush. Green hospital gowns were drying on clothes-lines and no one asked about sterility. The equipment of the laboratory was quite high-class but the sampling instruments seemed pre-historical. So, it could be clearly seen where the development assistance had been concentrating on. The basics had not been paid attention to but the technical side of things was in good order. In the afternoon, we had a great opportunity to meet Tanzanian Parliamentarians (Members of Tapama = Tanzania Parliamentarian against Malaria). They told extensively what have been done to prevent and eradicate malaria in Tanzania, and what we can do together. 30 % of Tanzania’s Parliamentarians are women and one third is under 30 years old. During our discussions, the effects of climate change on the spreading of malaria came up because viewed under current developments, it is not excluded that malaria will spread to Southern Europe as the climate becomes warmer. Therefore, Africa is by no means alone with this problem, even though at present the geographical location makes the problem biggest in Africa and Tanzania. A clear opinion was that if malaria was a problem of all peoples, it would have been dealt with a long time ago. We discussed also about the need of development cooperation and its allocation; if the eradication of malaria was genuinely invested in, how much the living conditions for example in Africa would improve and what it would mean in terms of the whole economy. Tue - Wed 18th – 19th Nov 2008 Early in the morning, we set out on a voyage towards Zanzibar. In
addition to the paradise island, we got to know to the malaria situation and the influential prevention work done in the island. We got to see in practice as people in a poor residential area, equipped with outfits reminding of the Ghostbusters-movies, sprayed insecticide into people’s accommodations to eliminate mosquitoes. During our visits in Zanzibar, we got to hear that using chloroquin in the prevention of malaria is failing in 60 % of the cases and therefore, in 2003, it was decided to change treatment and initiate a strong basic work in health care to prevent malaria. They switched over to use SP-medication (Sulfadoxine/Pyrimethamine) and adopted two research methods; scanning blood samples by microscopes and RDT (Rapid Diagnostic Test on a fingertip / supported by Americans). Zanzibar had achieved remarkable results in the prevention of malaria by guiding and instructing citizens through every possible media and daily face-to-face interaction. The houses were provided with insecticide spraying every six months and free malaria nets. Overall, the project lasted from six to ten years and cost three million dollars per year. The purpose of the project was to assure experts and donors that the work is bringing results and is worth continuing. The message was clear: only the sun can shine without a cost. Despite the motivated group and hard work done the results have not been achieved without financial assistance. It is worrying how the sustainability of the project and the situation in the island is secured. What if the donors withdraw now as the results have been achieved? One case describes the challenge: a modern and functional laboratory with full equipment had been unused for months after a malaria project had ended. Nothing new had been planned and the expensive equipment was standing in an empty space Thu 20th Nov 2008 After the meetings we travelled to Arusha. We visited a company supplying a
medicinal plant called Artemisia, a school and a factory producing malaria nets. Artemisia medicinal plant contains 32 different medicinal agents and is used in malarial treatment. We were told that Artemisia together with HIV-medication had changed HIV-test into negative after 8 months of using. The authenticity of the claim could not be verified but in general the plant seemed very interesting. The company had an agreement with farmers in the area. They had a clear social standpoint in their activities because their goal was to enhance the living conditions and economic situation of the people in the area through extensive cooperation. The manager of the company had a clear point of view that developed countries should support the small farmers in the area more than big medical companies so that cheaper medicine like Artemisia could be produced. The manager had been using Artemisia in his tea for a while and told that he had not contracted malaria. The plant grows into its full height approximately in 5 months, so its cultivation could be an opportunity to both medical industry and Tanzanian economy as it provides farmers with a secured livelihood. The visit to the Arusha School was immemorial with its musical performances and tours around the premises. We saw the dormitories of the students where they had mosquito nets treated with insecticide. The whole personnel and the students were present and the atmosphere was indescribably great. In the afternoon we took a bus to a factory producing malaria nets. There we got to see the whole manufacturing process of nets. The noise in the factory was deafening but not nearly all used protection for their ears. We asked managers about it and they answered it is voluntary. Therefore the noise was surely causing a lot of hearing defects among the employees of the factory. Fri 21st Nov 2008 On Thursday evening we traveled to Tanga. We visited the Bombo Hospital and the
Malaria Research Centre where the personnel proved to be highly educated and professional. The biggest surprise in the hospital was again the lack of basic competence and instruments. Two mothers with their newly born babies tried to lie on an 80 centimeters wide bed, almost toes in each others’ mouths. There were not enough beds, basic things were lacking and the hospital was understaffed. They were expected to get more staff within a few years but the question is how we will fix the basics, the foundation of all activity. The equipment of the laboratories was exceeding all expectations and I often wondered if they should invest a lot more in the basics so that the operation would be genuinely sustainable. High-tech microscopes and equipment do not strengthen the basic skills in the health care if not even basic patient Sat 22nd Nov 2008 We held a joint discussion where we deliberated upon the things seen and experienced
during the trip. We thought about what we could do together to move things forward in our home countries’ Parliaments and working groups. In many respects we felt great inner pain for not knowing how we can ever help enough people living in such poverty. The country holds many affluent and well-off people but also people living in extreme poverty. It is almost impossible to reach everybody. If the basics are in poor order, people do not have a roof from which to hang the mosquito nets or even a bed where to sleep in, how you can put the basics in order. Overall, it would be of our mutual benefit if malaria was genuinely eradicated from causing thousands of too early deaths. Malaria is not taken care of without an extensive and border-crossing cooperation. In this changing world, we cannot think that we can ignore this problem just because it is out of our sight. On the whole, the field visit was enlightening and influential. It left a lot to
Effectiveness of Leech Therapy in Osteoarthritis of the Knee A Randomized, Controlled Trial Andreas Michalsen, MD; Stefanie Klotz, RN; Rainer Lu¨dtke, PhD; Susanne Moebus, PhD, MPH; Gu¨nther Spahn, MD; and Gustav J. Dobos, MD Background: Leech therapy was commonly used in traditional arthritis Index and physical sum score of the Medical Outcomes medicine for treating localized pain.