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Namibia HEALTH CARE IN A WAR ZONE
1131 THERE are two practices in our little town, Ours and The Other, and so it has been for many years. In those far-off days when the war to end all wars had been fought, let alone its successors, the sire of Our Senior Partner and the progenitor of the Senior Partner of The Other Practice arrived on the same train on the same day and erected similar brass plates on similar houses in adjacent streets; ever since a stern spirit of rivalry has existed between the two
practices. Of course, it would be the Junior Partner who goes and upsets it is no good his bleating on about it being a mistake anyone could have made, let alone trying to put the blame on the council maintenance department. Our patient, Mrs Tomkins, lives at flat no 4 in the sheltered housing complex, and the message was that the door would be unlatched, doctor was to knock and walk in, as the old lady would be in bed. It is all very well for him to argue that, had the council refixed the figure 1" which had been removed by the local hooligan element from the door of no 14 he would not have gone to the wrong flat. This will not, in my opinion, wash; a modicum of common sense and a little basic numeracy (in the first of which, at least, the Junior Partner is, in my view, lacking) would have shown that the flat he approached was situated between numbers 12 and 15. Thus, allowing for common superstition and the consequent absence of 13, it was, a priori, likely to be no 14. In all fairness, I must, I suppose, concede a certain validity in his argument that, at this point, it was bad luck that Mrs Smithers of no 14 should also be expecting medical attention and have her door unlatched. Even worse luck was that, being deaf, she answered happily to "Mrs Tomkins"; worse still, she was a patient of The
things, and
"
Round the World From
our
Correspondents
Namibia HEALTH CARE IN A WAR ZONE
IN Namibia, the South African military presence means that there is one soldier for every twelve civilians. On Oct 29, at a seminar in London organised by SATIS (Southern Africa: the Imprisoned Society) Dr Solomon Amadhila, a paediatrician at Oshakati Hospital and one of Ovamboland’s few doctors, described the impact of the military on already stretched health care provision in this region. On Sept 29, 1988, a pregnant woman and her unborn baby died in a night exercise by South African troops; other incidents involving pregnancy include women blown up by a bomb and a landmine, another crushed by a military vehicle, and treponemal infection of mother and fetus after rape by a soldier. At Onandjokue Hospital, a 5-year-old girl was recently treated for severe genital injuries after rape by a soldier. Other deaths and injuries among the civilian Ovambo people of northern Namibia have been ascribed to military activity, including the erratic driving of army vehicles. Alcohol was unknown to the Khoi-San people (bushmen) until the army arrived; today alcohol abuse is prevalent. A dusk-to-dawn curfew is in force. In many rural communities families live in groups of huts within a fence that encloses their land. The toilet is sited in the open ground but the curfew extends to those wishing to leave their huts, for whatever reason. Anyone needing urgent medical help must wait until dawn or undertake a risky
journey. Excellent statistical records are available in the annual reports of the Lutheran Medical Mission. Among the leading causes of death, besides malnutrition and gastroenteritis, are hepatitis (which may be on the increase), bubonic plague, and measles. Primary health care in northern Namibia is ill organised and the immunisation programme has been impeded by the military presence-for example, it is dangerous for teams to travel to some areas in the war zone. Not all clinics associated with Onandjokwe Hospital have been affected; some have achieved increases in measles coverage but elsewhere protection rates, formerly at 80-90%, have fallen to near zero. However, Dr Amadhila recorded 645 measles admissions to the Oshakati government hospital in 1986 and 582 to the Onandjokwe Hospital of the Lutheran mission-"staggering
Other Practice. However, the nadir of ill-fortune was reached when the Senior Partner of The Other Practice walked in just as our Junior Partner was finishing his examination. I gather that the exchange that followed was warmish; the word "poacher" was freely used on both sides, Our Junior Partner still being under the impression that he was in rightful possession, the Senior Partner of The Other Practice knowing that he was not. Even when the mistake was discovered, there was no mutual laughing over the error, as by this time the matter was becoming personal. Our Junior Partner should not have called the Senior Partner of The Other Practice an ignorant old quack-not that it is an inaccurate description, mind you. Equally, the Senior Partner of The Other Practice should not have made remarks about Our Junior Partner-though I would, privately, be the first to agree that "wally" is the motjuste.
Anyhow the upshot was a letter of complaint from The Other Practice, putting them on top in the perpetual game of oneupmanship. Our Senior Partner was furious, the practice meeting tense. "You know," I said, "Mrs Smithers’ son is employed at the garage I use?" (I was careful to stick to the truth, and not say that he worked there.) "Well, he told me that, as a result of the row, the Senior Partner of The Other Practice did not actually treat his mother but stormed off in a temper; he asked me if he ought to complain. I suppose it is our duty to write to The Other Practice and ask them if they would like us to give him the address of the FPC?" I see the agenda for the next practice meeting includes receiving a letter of apology from The Other Practice. figures", he said "if one includes the other five hospitals plus those who are treated on an outpatient basis". Health services in Namibia are run on ethnic lines, with separate administrations for whites (6-5% of the population) and for every one of the other ten ethnic groups. 516 000 of the 1250 000 people in Namibia are Ovambo, so the consequences of South Africa’s wish to remain within striking distance of Angola and her refusal to allow any real progress towards an independent Namibia is affecting the lives and health of half the country.
Nicaragua AFTER THE HURRICANE
ON Oct 22 Hurricane Joan struck Nicaragua, bringing this beleaguered country to a point more critical than at any time in the six years of the contra war and economic blockade. Even the 1972 earthquake did not wreak such damage. In a land where 250 000 were already war refugees, a similar number (1 in 10 of the population) are now homeless and destitute. In Bluefields, the chief town on the Atlantic coast, with a population of 40 000, most of the houses were wooden, and 95% have been destroyed. The new hospital, which takes casualties from a large slice of the war zone, has lost its roof. The major economic activity in the area, fishing, may not recover for years. There is similar devastation inland. Floods have brought the danger of diarrhoea (already the cause of 50% of infant deaths in Nicaragua), typhoid, and malaria. The hurricane passed through productive farmlands, and in some areas 80% of the coffee crop has been obliterated, and almost all the rice has been lost. Six hundred schools have been destroyed. The economy is in ruins and the government will be unable to repair the infrastructural damage without assistance from abroad.** Most of the homeless need dry shelter, food, and uncontaminated water. The authorities have been attempting to move many of them nearer to Managua, and 100 000 are now in camps close to the capital. Relief work has been hampered by landslides and by the danger to transport in the war zone. There are reports that the have been exploiting the chaos, the contra leaders’ response suffering has been to urge that aid be kept away from the government agencies coordinating the relief work. contras to
the
*In London the Nicaraguan Health Fund a registered charity) has launched an appeal and is sending a container with blankets, bandages, and antibiotics. Offers of material aid or money should be sent to the fund at 83 Iiargaret Street, London V1X 7HB ’O 1 -580 4292 -
practices. Of course, it would be the Junior Partner who goes and upsets it is no good his bleating on about it being a mistake anyone could have made, let alone trying to put the blame on the council maintenance department. Our patient, Mrs Tomkins, lives at flat no 4 in the sheltered housing complex, and the message was that the door would be unlatched, doctor was to knock and walk in, as the old lady would be in bed. It is all very well for him to argue that, had the council refixed the figure 1" which had been removed by the local hooligan element from the door of no 14 he would not have gone to the wrong flat. This will not, in my opinion, wash; a modicum of common sense and a little basic numeracy (in the first of which, at least, the Junior Partner is, in my view, lacking) would have shown that the flat he approached was situated between numbers 12 and 15. Thus, allowing for common superstition and the consequent absence of 13, it was, a priori, likely to be no 14. In all fairness, I must, I suppose, concede a certain validity in his argument that, at this point, it was bad luck that Mrs Smithers of no 14 should also be expecting medical attention and have her door unlatched. Even worse luck was that, being deaf, she answered happily to "Mrs Tomkins"; worse still, she was a patient of The
things, and
"
Round the World From
our
Correspondents
Namibia HEALTH CARE IN A WAR ZONE
IN Namibia, the South African military presence means that there is one soldier for every twelve civilians. On Oct 29, at a seminar in London organised by SATIS (Southern Africa: the Imprisoned Society) Dr Solomon Amadhila, a paediatrician at Oshakati Hospital and one of Ovamboland’s few doctors, described the impact of the military on already stretched health care provision in this region. On Sept 29, 1988, a pregnant woman and her unborn baby died in a night exercise by South African troops; other incidents involving pregnancy include women blown up by a bomb and a landmine, another crushed by a military vehicle, and treponemal infection of mother and fetus after rape by a soldier. At Onandjokue Hospital, a 5-year-old girl was recently treated for severe genital injuries after rape by a soldier. Other deaths and injuries among the civilian Ovambo people of northern Namibia have been ascribed to military activity, including the erratic driving of army vehicles. Alcohol was unknown to the Khoi-San people (bushmen) until the army arrived; today alcohol abuse is prevalent. A dusk-to-dawn curfew is in force. In many rural communities families live in groups of huts within a fence that encloses their land. The toilet is sited in the open ground but the curfew extends to those wishing to leave their huts, for whatever reason. Anyone needing urgent medical help must wait until dawn or undertake a risky
journey. Excellent statistical records are available in the annual reports of the Lutheran Medical Mission. Among the leading causes of death, besides malnutrition and gastroenteritis, are hepatitis (which may be on the increase), bubonic plague, and measles. Primary health care in northern Namibia is ill organised and the immunisation programme has been impeded by the military presence-for example, it is dangerous for teams to travel to some areas in the war zone. Not all clinics associated with Onandjokwe Hospital have been affected; some have achieved increases in measles coverage but elsewhere protection rates, formerly at 80-90%, have fallen to near zero. However, Dr Amadhila recorded 645 measles admissions to the Oshakati government hospital in 1986 and 582 to the Onandjokwe Hospital of the Lutheran mission-"staggering
Other Practice. However, the nadir of ill-fortune was reached when the Senior Partner of The Other Practice walked in just as our Junior Partner was finishing his examination. I gather that the exchange that followed was warmish; the word "poacher" was freely used on both sides, Our Junior Partner still being under the impression that he was in rightful possession, the Senior Partner of The Other Practice knowing that he was not. Even when the mistake was discovered, there was no mutual laughing over the error, as by this time the matter was becoming personal. Our Junior Partner should not have called the Senior Partner of The Other Practice an ignorant old quack-not that it is an inaccurate description, mind you. Equally, the Senior Partner of The Other Practice should not have made remarks about Our Junior Partner-though I would, privately, be the first to agree that "wally" is the motjuste.
Anyhow the upshot was a letter of complaint from The Other Practice, putting them on top in the perpetual game of oneupmanship. Our Senior Partner was furious, the practice meeting tense. "You know," I said, "Mrs Smithers’ son is employed at the garage I use?" (I was careful to stick to the truth, and not say that he worked there.) "Well, he told me that, as a result of the row, the Senior Partner of The Other Practice did not actually treat his mother but stormed off in a temper; he asked me if he ought to complain. I suppose it is our duty to write to The Other Practice and ask them if they would like us to give him the address of the FPC?" I see the agenda for the next practice meeting includes receiving a letter of apology from The Other Practice. figures", he said "if one includes the other five hospitals plus those who are treated on an outpatient basis". Health services in Namibia are run on ethnic lines, with separate administrations for whites (6-5% of the population) and for every one of the other ten ethnic groups. 516 000 of the 1250 000 people in Namibia are Ovambo, so the consequences of South Africa’s wish to remain within striking distance of Angola and her refusal to allow any real progress towards an independent Namibia is affecting the lives and health of half the country.
Nicaragua AFTER THE HURRICANE
ON Oct 22 Hurricane Joan struck Nicaragua, bringing this beleaguered country to a point more critical than at any time in the six years of the contra war and economic blockade. Even the 1972 earthquake did not wreak such damage. In a land where 250 000 were already war refugees, a similar number (1 in 10 of the population) are now homeless and destitute. In Bluefields, the chief town on the Atlantic coast, with a population of 40 000, most of the houses were wooden, and 95% have been destroyed. The new hospital, which takes casualties from a large slice of the war zone, has lost its roof. The major economic activity in the area, fishing, may not recover for years. There is similar devastation inland. Floods have brought the danger of diarrhoea (already the cause of 50% of infant deaths in Nicaragua), typhoid, and malaria. The hurricane passed through productive farmlands, and in some areas 80% of the coffee crop has been obliterated, and almost all the rice has been lost. Six hundred schools have been destroyed. The economy is in ruins and the government will be unable to repair the infrastructural damage without assistance from abroad.** Most of the homeless need dry shelter, food, and uncontaminated water. The authorities have been attempting to move many of them nearer to Managua, and 100 000 are now in camps close to the capital. Relief work has been hampered by landslides and by the danger to transport in the war zone. There are reports that the have been exploiting the chaos, the contra leaders’ response suffering has been to urge that aid be kept away from the government agencies coordinating the relief work. contras to
the
*In London the Nicaraguan Health Fund a registered charity) has launched an appeal and is sending a container with blankets, bandages, and antibiotics. Offers of material aid or money should be sent to the fund at 83 Iiargaret Street, London V1X 7HB ’O 1 -580 4292 -