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Slums bear the brunt of African asthma
THE LANCET
POLICY AND PEOPLE
Indian states fail to reach development goals future demographic conditions and the time frame for meeting the ICPD goals”, the report notes. In rural India, doctors per 100 000 population rose from 3·3 in 1986–87 to 3·6 in 1991–92. In 1991, the number of hospital beds per 10 000 population was only 1·9 in rural areas and 21·8 in urban areas. But in rural Madhya Pradesh, Bihar, Rajasthan, and Uttar Pradesh it was 1·2, 0·4, 0·3, and 0·2 respectively, indicating a virtual absence of hospital-care facilities. Srinivasan believes that implementing the 1992 constitutional amendments would “plug the gaps” with elected bodies at village and city level responsible for basic health services. Panos
hree years after the International Conference on Population and Development in Cairo, the United Nations System in India has released the report India: Towards Population and Development Goals—a review of progress made by Indian states in achieving development goals by 2015. “Some states have made satisfactory progress but several others . . . are going Few beds for many so slow that they would take half a century to reach near the goals”, said K Srinivasan, co-author. The five problem states— Bihar, Madhya Pradesh, Orissa, Rajasthan, and Uttar Pradesh— account for 43% of the population yet have alarming child and maternal mortality rates. “What happens in these states will largely determine the
T
Sanjay Kumar
New ethical guidelines issued by the Vatican
T
he Vatican has just published a revision of its Catechism of the Catholic Church, with changes to medical ethics and human rights. Organ donation is now termed a “noble and worthy deed”, and animal experiments are considered morally justified, provided they remain within unspecified “reasonable limits” and “contribute to healing and saving human lives”. Unmodified are the Vatican’s positions condemning extramarital sex, contraception, homosexuality,
abortion, and euthanasia, although “withdrawal of expensive, dangerous or extraordinary medical procedures or those disproportionate with the expected results” may be warranted. The risk of shortening life with analgesia is acceptable if death is not the aim. But, despite the fifth commandment, the death penalty is “not excluded—provided the identity and the responsibility of the accused are fully ascertained”.
xperts at a regional seminar on asthma in Nairobi, Kenya, last month said the disease is stealthily emerging as a major killer of children under 5 years in Africa. Particularly hard hit are slum-dwellers on the periphery of big cities. “Inefficient disposal of urban solid waste has resulted in dumping in the slums, streets, and other open spaces”, said Christine Bü of the Centre for Microbiology Research in Nairobi. Samuel Gathua, head of chest diseases in the Kenyan Ministry of Health, said “The situation has created a fertile environment [for the] increase of dust mites, moulds,
874
sraeli courts have recently faced precedent-setting cases on medical practice. Early in September, the Tel Aviv District Court ruled that a severely retarded 8-year-old boy with terminal renal failure need not have a permanent dialysis catheter inserted against his parents’ will. The judge overturned a previous family-court decision, saying that the child’s suffering was the deciding factor. Earlier, the Court found the Ichilov Hospital in Tel Aviv negligent for failing to inform a woman that she was HIV-1 positive, for 6 years. The hospital and Health Ministry were ordered to pay NIS300 000 (US$87 000) compensation. Ram Ishay, chairman of the Israel Society of Medical Ethics, said that ethics committees should be formed to advise treating physicians and also court-appointed medical experts in difficult cases.
I
Rachelle H B Fishman
German “quack healer” sentenced
smoke, and other factors” implicated in asthma. Nairobi generates more than 100 000 tonnes of solid waste each month, and only a fraction is properly disposed. Eugene Weinberg from the University of Cape Town, South Africa said the situation is similar in other urban areas in Africa. In Nairobi, Lagos, and Kinshasa, asthma prevalence in adults is 7–10%, said Weinberg. But the prevalence in slums reaches 15–20%. In Kenya, 13% of all primary-school children have asthma, but the rate is much higher among slum children.
yke Geerd Hamer, the “miracle cancer healer”, was given a 19-month prison sentence on Sept 9 in Cologne, Germany, for illegal practice of medicine. He now faces further court cases over patients in Austria, among them 8-year-old Olivia Pilhar whose story hit the headlines in 1995. The Cologne trial covered only three German patients who were advised by Hamer to give up “official medical treatments”, to go on holiday, and to follow his “natural and psychological treatments”. They all died shortly after his treatment started. Hamer now faces trial over at least 65 patients he treated in Austria. Austrian justice would like to organise the trial on its soil, but, because Hamer is German, he has the right to choose whether to be judged in Austria or in Germany. He may also be charged again in Germany over patients not in the Cologne trial. In 1986, Hamer lost his right to practise medicine but kept on treating patients with his “natural methods”, based on the idea that cancer resulted from psychological troubles. He was first given a suspended sentence for illegal practice of medicine in Germany in 1993.
Anderson Wachira Kigotho
Denis Durand de Bousingen
Bruno Simini
Slums bear the brunt of African asthma
E
Israeli courts intervene in medical issues
R
Vol 350 • September 20, 1997
POLICY AND PEOPLE
Indian states fail to reach development goals future demographic conditions and the time frame for meeting the ICPD goals”, the report notes. In rural India, doctors per 100 000 population rose from 3·3 in 1986–87 to 3·6 in 1991–92. In 1991, the number of hospital beds per 10 000 population was only 1·9 in rural areas and 21·8 in urban areas. But in rural Madhya Pradesh, Bihar, Rajasthan, and Uttar Pradesh it was 1·2, 0·4, 0·3, and 0·2 respectively, indicating a virtual absence of hospital-care facilities. Srinivasan believes that implementing the 1992 constitutional amendments would “plug the gaps” with elected bodies at village and city level responsible for basic health services. Panos
hree years after the International Conference on Population and Development in Cairo, the United Nations System in India has released the report India: Towards Population and Development Goals—a review of progress made by Indian states in achieving development goals by 2015. “Some states have made satisfactory progress but several others . . . are going Few beds for many so slow that they would take half a century to reach near the goals”, said K Srinivasan, co-author. The five problem states— Bihar, Madhya Pradesh, Orissa, Rajasthan, and Uttar Pradesh— account for 43% of the population yet have alarming child and maternal mortality rates. “What happens in these states will largely determine the
T
Sanjay Kumar
New ethical guidelines issued by the Vatican
T
he Vatican has just published a revision of its Catechism of the Catholic Church, with changes to medical ethics and human rights. Organ donation is now termed a “noble and worthy deed”, and animal experiments are considered morally justified, provided they remain within unspecified “reasonable limits” and “contribute to healing and saving human lives”. Unmodified are the Vatican’s positions condemning extramarital sex, contraception, homosexuality,
abortion, and euthanasia, although “withdrawal of expensive, dangerous or extraordinary medical procedures or those disproportionate with the expected results” may be warranted. The risk of shortening life with analgesia is acceptable if death is not the aim. But, despite the fifth commandment, the death penalty is “not excluded—provided the identity and the responsibility of the accused are fully ascertained”.
xperts at a regional seminar on asthma in Nairobi, Kenya, last month said the disease is stealthily emerging as a major killer of children under 5 years in Africa. Particularly hard hit are slum-dwellers on the periphery of big cities. “Inefficient disposal of urban solid waste has resulted in dumping in the slums, streets, and other open spaces”, said Christine Bü of the Centre for Microbiology Research in Nairobi. Samuel Gathua, head of chest diseases in the Kenyan Ministry of Health, said “The situation has created a fertile environment [for the] increase of dust mites, moulds,
874
sraeli courts have recently faced precedent-setting cases on medical practice. Early in September, the Tel Aviv District Court ruled that a severely retarded 8-year-old boy with terminal renal failure need not have a permanent dialysis catheter inserted against his parents’ will. The judge overturned a previous family-court decision, saying that the child’s suffering was the deciding factor. Earlier, the Court found the Ichilov Hospital in Tel Aviv negligent for failing to inform a woman that she was HIV-1 positive, for 6 years. The hospital and Health Ministry were ordered to pay NIS300 000 (US$87 000) compensation. Ram Ishay, chairman of the Israel Society of Medical Ethics, said that ethics committees should be formed to advise treating physicians and also court-appointed medical experts in difficult cases.
I
Rachelle H B Fishman
German “quack healer” sentenced
smoke, and other factors” implicated in asthma. Nairobi generates more than 100 000 tonnes of solid waste each month, and only a fraction is properly disposed. Eugene Weinberg from the University of Cape Town, South Africa said the situation is similar in other urban areas in Africa. In Nairobi, Lagos, and Kinshasa, asthma prevalence in adults is 7–10%, said Weinberg. But the prevalence in slums reaches 15–20%. In Kenya, 13% of all primary-school children have asthma, but the rate is much higher among slum children.
yke Geerd Hamer, the “miracle cancer healer”, was given a 19-month prison sentence on Sept 9 in Cologne, Germany, for illegal practice of medicine. He now faces further court cases over patients in Austria, among them 8-year-old Olivia Pilhar whose story hit the headlines in 1995. The Cologne trial covered only three German patients who were advised by Hamer to give up “official medical treatments”, to go on holiday, and to follow his “natural and psychological treatments”. They all died shortly after his treatment started. Hamer now faces trial over at least 65 patients he treated in Austria. Austrian justice would like to organise the trial on its soil, but, because Hamer is German, he has the right to choose whether to be judged in Austria or in Germany. He may also be charged again in Germany over patients not in the Cologne trial. In 1986, Hamer lost his right to practise medicine but kept on treating patients with his “natural methods”, based on the idea that cancer resulted from psychological troubles. He was first given a suspended sentence for illegal practice of medicine in Germany in 1993.
Anderson Wachira Kigotho
Denis Durand de Bousingen
Bruno Simini
Slums bear the brunt of African asthma
E
Israeli courts intervene in medical issues
R
Vol 350 • September 20, 1997