Recent news from WHO

Bull World Health Organ 2010;88:488–489 | doi:10.2471/BLT.10.030710 489 News There is also the belief that miscarriages (due to Lassa fever) are caused by witch- craft, which may lead to delays in pre- sentation for treatment. However, there are also beneficial practices in the local culture and context: local populations have the knowledge, cultural logic and practices that arguably can and should be integrated into responses. Q: What are some examples of beneficial practices? A: An example of a local approach to these diseases comes from the work of an- thropologist Barry Hewlett, who learned how the Acholi people in Uganda deal with gemo (a word that means epidemic illness). Social protocols for prevention and control include isolating the patient in a house at least 100 metres from other houses; having a survivor of the epidemic feed and care for the patient; identifying houses with ill patients with two long poles of elephant grass; limiting general movement, advising people to stay within their household and not move between villages; and, finally, keeping patients who no longer have symptoms in isolation for one full lunar cycle before allowing them to move about freely in the village. Q: What are the implications if inter- national teams do not take local cultural beliefs into consideration? A: Top-down, standardized re- sponses and control measures have sometimes proved to be unsustainable, facing resistance from local populations. They may provoke local fears or feelings of injustice if people are restricted from moving or if they cannot bury their dead according to custom. An example of this occurred in 2001 in Gabon, where Euro- pean and American medical teams met armed resistance from local populations and had to leave. This was because vil- lagers remembered the control measures they had used for an earlier outbreak in 1995–96 as deeply offensive. Particu- larly troublesome was the prevention of customary burial practices. Sick and dead people were hidden behind tarpaulins in isolation units, which led people to suspect that their relative’s body parts were being stolen. This interplayed with a broader distrust of international teams “parachuted” in from outside. To avoid such situations in future, we need to build inclusive, participatory approaches that combine local and scientific knowledge. Q: Do you know of any outbreaks where traditional practices have been success- fully integrated with scientifically based approaches? A: One example is the 1999–2000 Ebola fever outbreak in Uganda, in which the Acholi cultural model and practices were incorporated; another was the out- break in the Democratic Republic of the Congo in 2001. But more generally, policy seems to have shifted among many agencies and WHO, for example, now routinely tries to incorporate local cul- tural practices into all outbreak responses. Q: What are some of the longer-term driv- ers of these diseases? A: We need to piece together many different causes and effects, but some relate to long-term environmental and socio-ecological dynamics. Deforestation through agriculture and logging, and the consumption and trade of bushmeat, can contribute to haemorrhagic fevers by bringing populations closer to their forest animal viral reservoirs and second- ary vectors. Climate change plays a role, influencing dynamics on the forest fron- tier. Poverty and inequality, sometimes enhanced by conflict, also cause problems such as declining health systems and overcrowded hospitals. Poor hospitals are well recognized to be key amplifiers of Ebola infection, while overcrowded and poorly-constructed settlements associated with impoverished and conflict-affected communities provide ideal conditions for exposure to Lassa fever. Q: How can we use the innate fear of Ebola in a positive way to develop an effective response to other diseases? A: Ebola haemorrhagic fever is sen- sationalized because it is very scary. But there are ways in which we can harness the resources and experiences to address other health priorities, such as insisting on safe practices when handling body fluids for prevention of infectious dis- eases in general. We also must be careful that a disease outbreak doesn’t distract from providing an integrated response to health problems. People who live in the areas that suddenly attract attention from the international community owing to an Ebola fever outbreak may have been dealing with HIV infection, malaria, diar- rhoea and other health problems that are regarded as far more important to them in a day-to-day sense. Professor Melissa Leach was inter- viewed as a guest speaker of the World Health Organization’s global health history seminar series. Access the seminars online at: http://www.who.int/global_health_ histories/seminars/en/ ■ Recent news from WHO • On 31 May World No Tobacco Day was launched at the Japanese Ministry of Health in Tokyo. This year’s theme focused on the harmful effects of tobacco marketing towards women and girls. Women are a major target for the tobacco industry as it attempts to recruit new users to replace those who will quit or die prematurely from tobacco-related diseases. Tobacco is the leading preventable cause of death and kills more than five million people every year, about 1.5 million of whom are women. At the launch, the World Health Organization (WHO) presented a new publication: Gender, women and the tobacco epidemic. • On 3 June 2010, the Countdown to 2015 decade report (2000–2010): taking stock of maternal, newborn & child survival was launched at the Women Deliver conference in Washington, DC, United States of America. The 2010 report examines 68 countries where more than 95% of all maternal and child deaths occur. The report calls for more political action and investment to develop basic services that could save millions of lives a year. • On 14 June World Blood Donor Day 2010 was launched in Barcelona with a slogan “New blood for the world”. The global campaign hopes to recruit and retain a new generation of motivated, voluntary unpaid blood donors. The launch was hosted by the Spanish and Catalonian health authorities and donor associations with the Spanish Red Cross. For more about these and other WHO news items please see: http://www.who.int/mediacentre