Dorothy Logie

Africans die in pain because of fears of opiate addiction

Attempts to improve palliative care services in Africa are being hampered by the fear that many African professionals have of using morphine therapeutically and by poor access to the drug, a conference was told last month.⇓ Many countries in Africa have no access to morphine so that palliative care is reduced to the level of supportive care without pain relief, delegates from 35 countries heard. They were attending the second palliative care conference for Africa, in Nairobi. While the worlds 20 richest countries consume 86% of global therapeutic morphine, countries such as Rwanda use just 0.039 mg per …

Global voices on HIV/AIDS. Unfairness of social and economic structures affect AIDS in Africa.

Editor—The fact that health is fragile and determined less by health services than by the relative fairness of social and economic structures was missing from the debate on global AIDS.1 Sub-Saharan Africa contains 10% of the worlds population and bears 70% of the global burden of HIV/AIDS. It also exists on 1% of the global economy and, with the recent economic slump, this figure is falling. In January Zambia heard that the mining group AngloAmerican is pulling out of copper production (which accounts for 75% of the countrys export earnings). The mines are likely to close in the next 10 months, putting 9500 miners and 1600 other workers out of work. These men will migrate in search of new work—one of the many social factors contributing to the epidemic. HIV has gained the biggest foothold in poor countries with rising unemployment and declining health and educational services. Over the past 20 years the World Bank and the International Monetary Fund have conducted a massive social experiment in poor African countries. It is called structural adjustment and has encouraged privatisation of industry, such as Zambias copper mines, increased unemployment, cut food subsidies, and introduced charges for health and education. The ideology of structural adjustment has recently been repackaged and renamed poverty reduction strategy and programmes with the intention of giving countries ownership of reducing poverty. But the basic macroeconomic programme is not for discussion. Africa urgently needs a realistic evaluation of the continuing effects of debt and neo-liberal economic prescriptions on the health of its people. It also needs increased aid. The Global Fund for AIDS, Tuberculosis, and Malaria must be supported by new money: the United Kingdoms pledge of £75m (

Cancellation of debt of poorest people would be worthy memorial to millennium

108m; €123m) is to be taken from money already earmarked for aid. The money must be used to boost health services as a whole. AIDS will not be controlled in the long term by antiretroviral drugs, or even by a vaccine, without examination of the wider social, political, and economic factors that create disease and conditions of risk.

A lesson in Indonesian

Editor—Andrew Haines and Richard Smith rightly argue that the increasing disparity in wealth, between and within countries, is having such a profound effect on health that doctors must cooperate with others to analyse the “pathology” of poverty and lobby for change.1 Medical Action for Global Security, the British affiliate of International Physicians for the Prevention of Nuclear War, is doing just that. By linking with health professionals globally and by working with economists, we are examining …

AIDS cuts life expectancy insub-Saharan Africa by a quarter

The British prefer definite answers. Let your yea-yea be your yea-yea. No greys, please. Is the IRA ceasefire permanent: yes or no? In Indonesia there is a word in common use that nicely circumvents the need for black and white. …