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Sierra Leone continues to struggle for relief from Lassa fever
THE LANCET
POLICY AND PEOPLE
Sierra Leone continues to struggle for relief from Lassa fever
T
he peace agreement signed last month, which will see the democratically elected president back in power in April, 1998, should have been good news for Sierra Leone. But the country is still in the grip of the worst-ever Lassa-fever epidemic. And continued fighting is making conditions increasingly difficult. In May, 1996, WHO declared Lassa fever to be epidemic—attributed to the destruction of health infrastructure during the civil war, and the mass migration then congregation of displaced people from rural areas. The medicalrelief charity MERLIN has provided all Lassa-fever services since case numbers started rising again in December, 1996. The country’s only treatment ward was established in Kenema, along with primary-care centres throughout the Lassa belt. Part of the clinics’ role was to detect and arrange transfer of suspected cases to the Kenema ward. In the first 4 months of 1997, MERLIN treated 356 clinical cases. Laboratory confirmation has been
available only retrospectively, by the Centers for Disease Control and Prevention (Atlanta, GA, USA). So, treatment regimens have included drugs for malaria and typhoid as well as ribavirin. The case-fatality rate, which untreated can be as high as 80%, fell from 29% in 1996, to 14·6% by April, 1997. After the May, 1997, political coup, fighting has been concentrated in the Lassa belt, because of the diamond mines located in the area. MERLIN saw its clinics looted and staff flee. Transport of patients from the disease epicentres became impossible. “We have no reason to think that the epidemic has waned”, says Richard Allan, medical advisor for MERLIN. “But we have huge reason to think that people are dying in the bush.” No official information has been available, with intermittent reports coming via ProMED-mail, the online service that monitors emerging diseases. MERLIN has now opened seven clinics, but because of the continued insecurity, only two are old clinics in
“Mercy killing” takes centre stage in Canada
I
ssues of euthanasia and doctorassisted suicide took centre stage in Canada last week. But Federal Justice Minister Anne McLellan seemed unphased by the uproar, saying that while the federal government may “consider” legislation granting sentencing leniency in exceptional second-degree murder cases, it currently has no intention of honouring Prime Minister Jean Chretien’s 1994 promise to allow a free vote in parliament on “mercy killing”. But New Democrat MP Svend Robinson dismissed McLellan’s contention that legislatures are not the best venue in which to resolve the profound ethical issues surrounding assisted suicide and euthanasia. Robinson has introduced a bill proposing a free vote on whether to establish a committee to reform law. Earlier in the week, a Saskatchewan farmer was convicted of second-degree murder after the death of his 12-year daughter, who had cerebral palsy. He gassed the
1458
child in the cab of a pickup truck. Canadian law obligates the courts to issue mandatory life-imprisonment sentences for second-degree murder convictions with no eligibility for parole for at least 10 years. But the farmer’s lawyer will ask the trial judge this week to waive the mandatory minimum 10-year parole rule. Across the country, crown prosecutors reduced a first-degree murder charge against Halifax doctor, Nancy Morrison, to manslaughter in a case involving the death of 65-year-old cancer patient (see Lancet 1997; 349: 1458). Crown prosecutor Craig Botterill told reporters a life sentence with no eligibility for parole in 25 years would be “harsh and oppressive”, should she be convicted at trial next year. In Canada, manslaughter is the unintentional taking of life by an illegal act; firstdegree murder is the deliberate execution of a planned taking of a life. Wayne Kondro
the Lassa zone. Efforts to reopen other clinics have proved impossible. And in the past 2 weeks, Kenema has come under daily heavy aerial bombing. But, “MERLIN is committed to providing vital support for as long as is needed”, says Allan. Other factors have conspired to worsen the situation, including the erratic supply of ribavirin. The sole patented manufacturer stopped production of the drug in 1996 for technical reasons. Although a supply is now available, donated by China, disease surveillance and public-health measures remain the best options for controlling the epidemic.These activities are severely restricted while peace and political stability remain elusive in the area. According to the Council of Churches, Sierra Leone now faces “the spectre of starvation”, since the fighting has disrupted food production. The United Nations Food and Agriculture Organization has declared a special alert stating that “the country will continue to rely heavily on food aid”. The peace accord, which was greeted internationally with optimism, seems to have brought little relief. Kelly Morris, Charles Calisher
Exhumation angers French ethicists
O
n Nov 6, the Paris Court of Appeal ordered the exhumation of the corpse of the French singer Yves Montand, who died in 1991. A DNA sample will be taken. Since 1989, Aurore Drossard has claimed that Montand is her father, but the singer never recognised her as such and refused genetic testing. The Court considered that Drossard had a right to know who her father was. Geneticists and bioethicists criticised the Court’s decision, and the French Committee of Bioethics also expressed concern. According to Prof Axel Kahn, a member of the committee, the French bioethics regulations guarantee the right of any person to accept or to refuse any test, but does not clearly state whether that wish remains valid after death. But it is considered that wishes should be respected after death, even if there is no written confirmation.
Denis Durand de Bousingen
Vol 350 • November 15, 1997
POLICY AND PEOPLE
Sierra Leone continues to struggle for relief from Lassa fever
T
he peace agreement signed last month, which will see the democratically elected president back in power in April, 1998, should have been good news for Sierra Leone. But the country is still in the grip of the worst-ever Lassa-fever epidemic. And continued fighting is making conditions increasingly difficult. In May, 1996, WHO declared Lassa fever to be epidemic—attributed to the destruction of health infrastructure during the civil war, and the mass migration then congregation of displaced people from rural areas. The medicalrelief charity MERLIN has provided all Lassa-fever services since case numbers started rising again in December, 1996. The country’s only treatment ward was established in Kenema, along with primary-care centres throughout the Lassa belt. Part of the clinics’ role was to detect and arrange transfer of suspected cases to the Kenema ward. In the first 4 months of 1997, MERLIN treated 356 clinical cases. Laboratory confirmation has been
available only retrospectively, by the Centers for Disease Control and Prevention (Atlanta, GA, USA). So, treatment regimens have included drugs for malaria and typhoid as well as ribavirin. The case-fatality rate, which untreated can be as high as 80%, fell from 29% in 1996, to 14·6% by April, 1997. After the May, 1997, political coup, fighting has been concentrated in the Lassa belt, because of the diamond mines located in the area. MERLIN saw its clinics looted and staff flee. Transport of patients from the disease epicentres became impossible. “We have no reason to think that the epidemic has waned”, says Richard Allan, medical advisor for MERLIN. “But we have huge reason to think that people are dying in the bush.” No official information has been available, with intermittent reports coming via ProMED-mail, the online service that monitors emerging diseases. MERLIN has now opened seven clinics, but because of the continued insecurity, only two are old clinics in
“Mercy killing” takes centre stage in Canada
I
ssues of euthanasia and doctorassisted suicide took centre stage in Canada last week. But Federal Justice Minister Anne McLellan seemed unphased by the uproar, saying that while the federal government may “consider” legislation granting sentencing leniency in exceptional second-degree murder cases, it currently has no intention of honouring Prime Minister Jean Chretien’s 1994 promise to allow a free vote in parliament on “mercy killing”. But New Democrat MP Svend Robinson dismissed McLellan’s contention that legislatures are not the best venue in which to resolve the profound ethical issues surrounding assisted suicide and euthanasia. Robinson has introduced a bill proposing a free vote on whether to establish a committee to reform law. Earlier in the week, a Saskatchewan farmer was convicted of second-degree murder after the death of his 12-year daughter, who had cerebral palsy. He gassed the
1458
child in the cab of a pickup truck. Canadian law obligates the courts to issue mandatory life-imprisonment sentences for second-degree murder convictions with no eligibility for parole for at least 10 years. But the farmer’s lawyer will ask the trial judge this week to waive the mandatory minimum 10-year parole rule. Across the country, crown prosecutors reduced a first-degree murder charge against Halifax doctor, Nancy Morrison, to manslaughter in a case involving the death of 65-year-old cancer patient (see Lancet 1997; 349: 1458). Crown prosecutor Craig Botterill told reporters a life sentence with no eligibility for parole in 25 years would be “harsh and oppressive”, should she be convicted at trial next year. In Canada, manslaughter is the unintentional taking of life by an illegal act; firstdegree murder is the deliberate execution of a planned taking of a life. Wayne Kondro
the Lassa zone. Efforts to reopen other clinics have proved impossible. And in the past 2 weeks, Kenema has come under daily heavy aerial bombing. But, “MERLIN is committed to providing vital support for as long as is needed”, says Allan. Other factors have conspired to worsen the situation, including the erratic supply of ribavirin. The sole patented manufacturer stopped production of the drug in 1996 for technical reasons. Although a supply is now available, donated by China, disease surveillance and public-health measures remain the best options for controlling the epidemic.These activities are severely restricted while peace and political stability remain elusive in the area. According to the Council of Churches, Sierra Leone now faces “the spectre of starvation”, since the fighting has disrupted food production. The United Nations Food and Agriculture Organization has declared a special alert stating that “the country will continue to rely heavily on food aid”. The peace accord, which was greeted internationally with optimism, seems to have brought little relief. Kelly Morris, Charles Calisher
Exhumation angers French ethicists
O
n Nov 6, the Paris Court of Appeal ordered the exhumation of the corpse of the French singer Yves Montand, who died in 1991. A DNA sample will be taken. Since 1989, Aurore Drossard has claimed that Montand is her father, but the singer never recognised her as such and refused genetic testing. The Court considered that Drossard had a right to know who her father was. Geneticists and bioethicists criticised the Court’s decision, and the French Committee of Bioethics also expressed concern. According to Prof Axel Kahn, a member of the committee, the French bioethics regulations guarantee the right of any person to accept or to refuse any test, but does not clearly state whether that wish remains valid after death. But it is considered that wishes should be respected after death, even if there is no written confirmation.
Denis Durand de Bousingen
Vol 350 • November 15, 1997