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Posted on 05/04/2005 12:42:04 AM PDT by Judith Anne
Welcome to the Marburg Surveillance Project.
This thread will be used for all of the latest Marburg Outbreak News and comments. This is the place to post all comments about the Marburg outbreak, all articles and links to articles about the Marburg outbreak.
We're going to use just one thread instead of having to go from article to article as we have in the past. We'll use this thread as long as we can.
Bump.
From http://www.canada.com/health/story.html?id=475eda5e-ecf6-4e93-b617-6760ddfd272d&page=2
Cultural and traditional medicine practices frustrating control of deadly outbreak
Emma Ross
Canadian Press
Friday, May 27, 2005
GENEVA (AP) - Health experts trying to stamp out the worst ever outbreak of the deadly Marburg virus are focusing more attention now on the dangerous practices performed and recommended by traditional healers in Angola.
Treatments such as herbal infusions delivered as enemas, together with a local culture that believes injection is the best way to take everything from vitamin supplements to pain killers, are among the key factors driving the continuation of the outbreak in the Uige province of northern Angola, World Health Organization scientists said Thursday.
The outbreak, which was first identified March 21, has been contained in Uige. The peak has now passed and the number of infections is tailing off, but new cases are still emerging and any one of these could spark a new crisis, said Dr. Mike Ryan, the WHO's outbreak response director. So far, the toll stands at 380 cases, of which 318 have died.
In the absence of a vaccine or drugs for the disease, traditional healers have been filling the gap, selling treatment and vaccine concoctions that not only don't work, but also are likely making the problem worse, said Pierre Formenty, the WHO's hemorrhagic fever expert co-ordinating efforts at the scene of the outbreak.
Although the remedies themselves are probably not harmful, they create a false sense of reassurance, lulling people into believing they are protected from contracting or transmitting the infection, which makes them less likely to be vigilant about taking precautions.
The method of administration is the greatest cause for concern, Formenty said.
"The cure they are selling is a sort of soup based on plants, most of the time. They administer it in the rectum. For the vaccine, there is a drink," Formenty said. "Most of them have claimed to have treated hundreds, if not thousands, of Marburg patients."
"They say they are wearing gloves and that they are not using needles, but they are still claiming to have cured Marburg patients with their soup," Formenty said. "We hope they are just drinking it."
Much of the time the treatments are sold in markets and the healers advise customers how to use it at home.
"Nobody is trying to harm anyone here. They are trying to help in the way that they think they can help but it's become a very commercialized practice and introducing any kind of probe into the rectum is dangerous because it can cause bleeding. If that person has the infection and you reuse the probe, it can transfer the disease to the next person," Ryan said from the WHO's headquarters in Geneva.
Another unhelpful cultural practice is the reliance on syringes to deliver even the most basic of medicines.
"There are also partially trained nurses going from suburb to suburb giving vitamin injections to people to help them fight infection. But if they are reusing the needles - and we believe they are - it could play a role in the transmission of the disease."
To combat the problem, international health experts are now focusing on gently trying to get greater co-operation from the traditional healers and other private practitioners. They held a major training workshop for more than 100 traditional healers in Uige on Wednesday, to educate them on the nature of the disease and safety precautions such as wearing gloves, proper disinfection and not using any instruments.
Addressing the problem of the traditional healers is a sensitive task and if it is mishandled, it could be disastrous for the effort to control the disease, Ryan said.
"The population is just coming out of 27 years of war . . . and there's a general mistrust of outsiders," Formenty explained.
WHO officials have registered 157 traditional healers in Uige.
"They were the ones who looked after the people during the war. They never closed their offices and they are therefore trusted by the population."
Keeping the community on board is crucial to success, Ryan said.
"If you push too hard and you try in any way to humiliate the traditional healers, who are relied upon by the community, you will drive the whole thing underground and then we'd have a much more serious problem," he said.
"You have to strike a fine balance between the communities feeling their system is being criticized and losing their involvement, and doing what medically and scientifically is the right thing to do - which would be to get all of the needles and the traditional healers out of the equation for the period of the response," Ryan said.
Scratch that. It is the Ministry of Health that stated 399 cases and the WHO that said 380. Regardless, the deliberate lack of communication by the Angolan government is why this is getting more out of control by the day. I attribute this to the stupid soccer game they wanted to host (at any cost).
Angola's epidemic of Marburg hemorrhagic fever reached 399 cases with 337 deaths yesterday, an increase of 62 cases and 24 deaths in the preceding 8 days, according to a new World Health Organization (WHO) statement.
The agency had reported 337 cases, including 311 deaths, on May 18.
The epidemic is still concentrated in the northern province of Uige, which accounts for 388 cases and 324 deaths, the WHO reported.
Who really knows, but the way I read it this means that there are (399-388) 11 active cases outside Uige and there have been (337-324) 13 deaths outside Uige.
The peak has now passed and the number of infections is tailing off, but new cases are still emerging and any one of these could spark a new crisis, said Dr. Mike Ryan, the WHO's outbreak response director
The number of active cases are growing not declining. So how can one say it has reached a peak? A peak means the number of active cases are getting less each day not more. How stupid do the authorities think THE PEOPLE are?
Well there is your 4000 bedding changes.
I really think that when they are giving out so-called numbers here, they are ONLY counting the ones treated by them in a hospital. They have to know about all the ones at large in the community because they admit to going out and looking for them, but unless they actually die in the hospital, they are not officially counted.
If so, YIKES!
It's ridiculous that we have to read between the lines in order to get any information out of these groups, or wait for them to slip up, such as the 4000 mattresses story.
I really think that when they are giving out so-called numbers here, they are ONLY counting the ones treated by them in a hospital. They have to know
and I am sure that only cases that have been labratory confirmed are counted ... that was part of the initial administrative reclassification.
From post 1611 above (google translation):
But for many inhabitants of Uige, l'hôpital provincial remainder synonymous with death. Not only because the patients die there, but also because l'hôpital is l'un principal hearths of l'epidemy. With l'origine, they are d'abord the children of the service of pediatry who died, then their mothers, then the personnel of health - 16 lost the life and the disease is spread with their close relations.
"Lorsqu'il has there as many death, people always seek a culprit" , explains Pasteur Alberto Moisés, in front of the teams of MSF and world l'Organisation of health (WHO) which come to seek a body in the barrio of Pedreira. "They say that Marburg is in l'hôpital and that whoever s'en approach dies. Many people fled in Luanda (the capital) or towards the villages."
... To convince the population that l'isolement patients is necessary s'apparente to a task herculéenne. A team of MSF recently organized a meeting with the representatives of the barrio of Pedreira. L'importance d'amener the cases with l'hôpital - even s'il n'y has any - treatment was discussed during hours. C'est then qu'un traditional guerissor intervened: "J'ai a remedy. And j'ai already cured five people ", claimed it, unable to however give the name d'une only. Suddenly, all the participants in the meeting - including those which seemed the most convinced of the d'isoler need the patients - started to ask that the traditional remedy be applied. Two short sentences had been enough to reverse the course of the meeting.
"The cure they are selling is a sort of soup based on plants, most of the time. They administer it in the rectum. For the vaccine, there is a drink," Formenty said. "Most of them have claimed to have treated hundreds, if not thousands, of Marburg patients."
Thanks for posting today. I have had a feeling, with no facts to back it up (just my judgement and reasoning from what I've learned) that the case numbers were magnitudes of order higher than anything that was reported.
The 4000 mattresses thing--that HAS to indicate that actual cases are likely up to 10 times higher than the Angolans or anyone is reporting. That, and the reported level of panic--for a province with a population in the millions to be panicking over a disease that claimed less than 500 lives in the past 4-5 months did not make sense--until today. After all, mortality from normal diseases there is pretty high, and no one panics...
This really is a nightmare. God have mercy on Angola!
I really got a lot out of your post, thank you. The way Ryan is talking, there are no other diseases for the traditional healers to help with, only Marburg...this is another indication to me that the epidemic numbers are far higher than anyone is indicating. Even though it's indirect, this discussion of getting rid of "all the needles and the traditional healers" (157 of them registered in Uige) if there are only 400 Marburg cases seems like over-reacting If, however, the true Marburg numbers are far higher, it begins to make sense.
"First, if you figure that we have about 30 active cases during the last week, then you would expect 30 additional deaths in a week. However, if you have followed this epidemic, you will know that the numbers never added up. There were no known survivors, but the death count did not increase to account for the number of active cases."
Something doesnt add up there...'cooked' numbers?
Why isn't WHO releasing their OWN numbers?
Maybe because they know if they did release their 'internal' numbers those would be different [far worse?] than the MoH claims and they dont want to 'jeopardize relations' with their 'hosts'?
Could this be related somehow to MSFs untimely departure?
I have a bad feeling about this;
*in Jack Nicholson voice*
"You can't hannndle the Truth..." ???
:-(
Does anyone know if Marburg virus can 'live' long enough in fleas on Dogs to be a vector?
That it's spreading out is most worrisome...is it possible that its only a matter of proper containment measures not being properly applied or does this suggest that the standard measures are not being effective with this strain of Marburg?
LOL - "the authorities" insult our intelligence on a wide variety of subjects daily...they think we are all VERY stupid it seems.
If that was actually true then we might as well write Angola off...they're TOAST...
But I think it's more likely the 'witch doctors' are just claiming such numbers to attract 'business'.
Yeah the 4000 matresses is very discouraging...if the numbers are really THAT much worse than what they are claiming then the recent Army briefings begins to make sense...
I'm going to have to ask a rather disturbing question;
At what point in an epidemic/pandemic does TRUE Morality have to switch focus from Compassion to Triage???
By 'whatever means necessary'??? :-(
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