Sudanese Nectar

Sudan HIV/AIDS Working Group (SHAWG)

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Sun, 11 Jan 2009 12:23:34 PST

I have recently been involved with the newly founded Sudan HIV/AIDS Working Group (SHAWG) http://www.shawg.org . SHAWG is a voluntary network of healthcare professionals with special interest in HIV/AIDS aiming to contribute to the HIV/AIDS control activities in the Sudan. SHAWG delivered an advanced training workshop on the management of HIV in August 2008, which was attended by 51 physicians from all over Sudan. Further rounds of training are planned with 6 monthly intervals.

The birth of SHAWG gives further impetus to the HIV control efforts in Sudan. The UNDP/TOKTEN (SUDAN) programme has warmly embraced SHAWG and facilitated our activities http://www.sd.undp.org/story%20tokten.htm

Sudan doctors in the spotlight: A rapid response to Osman Mirghani's article

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Sat, 28 Jun 2008 14:06:27 PDT

Dear Osman,

I have read with interest what you wrote today on Alsudani newspaper.

I find it hard to believe that the Sudan constitution (or any constitution) may endorse bestowing unlimited power or authority on the medical profession (or indeed any other profession). I think it would have been fairer to say that the rules regulating the medical profession, which should be there to protect patients, are not clear and therefore not easily enforceable by law.

Doctors in Sudan are held in high regard by the society and this makes most of us (the public) shy away from questioning their authority. This is further complicated by the fact that spiritual and religious dimensions to illness and death in our society make it easier to accept these events even if they were a direct result of medical negligence!! This is particularly a powerful coping mechanism for many bereaved relatives in Sudan; especially we all believe that every one of us live numbered days in this world. However, I fully subscribe to the notion that doctors and -other professionals- should be held accountable for their acts whether good or bad. The question is how to create accountability systems for each profession in Sudan?

I agree with you that uttering a few words in a ceremonial atmosphere is not worthy the effort and money spent in such gatherings. Instead, we should be seriously looking into establishing accountability within the healthcare system whereby doctors (and nurses, midwives, .. etc) are judged on their performance. For example, here in the UK we have what is known as clinical governance system which aims at ensuring the highest possible safety and quality of clinical care in each hospital by using certain tools. A good example of such tools is clinical audit (in which doctors/nurses etc compare the outcomes of certain aspects of their clinical practice with an agreed national standard of care). Clinical audit has indeed enlightened the practice of many doctors and helped bring about changes that contributed to better quality of care. By contrast, national standards of care are almost non-existent in Sudan (I will be pleasantly surprised if somebody proves the opposite) let a lone the practice of audit in itself. Furthermore, the number of private practitioners in Sudan has rocketed over the past decade and this poses more difficult questions than ever as to how to regulate their practice.

The tradition in Sudan, and other countries, has been to rely on national medical councils to regulate the practice. Of interest, this concept is being increasingly challenged in the Western hemisphere as the medical council (usually led and partly funded by doctors through regular compulsory subscriptions) is by definition committed to promoting the interests of doctors and therefore cannot be seen as an impartial referee in disputes or complaints made against doctors. In response to such concerns, most Western medical councils have got lay members (selected from the public) represented in various committees in order to bring a sense of balance. However, some doctors view the council as unfair and heavy-handed on doctors whenever a dispute arises and they think this is driven by a desire to please the public at the expense of their careers.

On reflection on the Sudan situation, the medical council in Sudan found itself in the media spotlight on several occasions recently because of reports of medical mishaps or misconduct in the profession. This is certainly indicative of rising awareness among the public with regards to their basic rights and we should all welcome this. A note of caution, however, is that trying to demonize doctors is not going to be particularly helpful. We have to remember that the vast majority of doctors work in poorly resourced healthcare facilities and that they have to make ends meet in their day to day life (just like anybody else) in order to support their families.

The challenge facing the medical council in Sudan now is to rejuvenate itself, engage in a constructive dialogue with both doctors and patients, and work towards protecting patients’ interests whilst promoting good medical practice. This process should be matched by a similar effort from the Ministry of Health to establish transparency and accountability within the existing healthcare system. Medical schools should also play a key role in ensuring that our would-be doctors have good grounding in communication skills (doctor-patient relationship, bedside manners, etc) and medical ethics (patient’s right to confidentiality, respect of patient’s autonomy, etc)

I have no doubt that the Sudanese people deserve first class healthcare services but we need to work TOGETHER to fulfil this objective. Of course, everybody should be conscientious when they go about their daily jobs as this is part and parcel of our religious and moral values. Therefore, I would expect not only doctors but also shopkeepers, plumbers, mechanics, local politicians, …etc.. etc to bear this in mind when we (the public) ask them to serve us!

For the full article by Osman Mirghani, please click on the link below

http://www.alsudani.info/index.php?type=6&issue_id=1592&col_id=132&bk=1

Mentoring healthcare professionals in the developing world

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Fri, 11 Apr 2008 13:01:39 PDT

I spoke earlier this week to one of my GU colleagues who returned recently from a six-week trip to South Africa. She was very excited telling me about her mentoring experience in South Africa. She joined an NGO called International Center for Equal Healthcare Access (ICEHA) which collaborates with sister organisations working in HIV care. The latter has to be engaged in a partnership with local bodies, e.g. Ministry of Health or other national agencies.

My colleague's role, along with another expatriate nurse practitioner from the US, was to support clinicians working in a government-run HIV clinic. This involved a one-to-one training in WHO guidelines on the management of HIV/AIDS, improving note-keeping systems, basic management of drugs and other consumables, etc. My colleague made it clear that they wanted to work with what's available locally rather than imposing solutions from outside that are unlikely to be sustained in the long run.

While listening to her, my mind kept travelling to Sudan and I wished I, or others, could do a similar job. HIV/AIDS care in Sudan is still in its infancy and the high degree of stigma attached to its name make medical practitioners steer away from taking part in it. This will ultimately result in undermining an already struggling service.

For further information on ICEHA model, please visit their website at http://www.iceha.org/model/

WHO annouces erradication of Polio in Somalia

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Wed, 02 Apr 2008 08:16:12 PDT

The Global Polio Eradication Initiative (GPEI) announced yesterday that Somalia has not reported a single case of Polio over the past 12 months. Based on that, Somalia has been declared polio-free. For full details of the press release, please click on the link below

http://www.who.int/mediacentre/news/releases/2008/pr09/en/index.html

I feel a little bit concerned about such statements. In view of the decaying security situation, I feel under reporting of polio cases, due to insecurity for example, could give a false impression of eradication. The recent surge in violence in Somalia has prompted 40 aid agencies to sign a press release warning about impending catastrophe in the war-torn East African country. Please click on the link below for further information.

http://news.bbc.co.uk/2/hi/africa/7313911.stm

The New Horizons' Sun

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Sat, 15 Mar 2008 09:23:21 PDT

شمسُ المدارات ِ الجديدة

***١***
الأنَ تسطعُ فى سمائكَ

شمسُ المدارات ِ الجديدة

ِتعبرُ خط استوائكَ

لتهديكَ امراءةً تشعلُ النارَوتزهو بانتمائكَ

تذيبُ الحشا منكَ قوافياً هزها هولُ احتراقكَ
***٢***
ما زانَ مجدَكَ غيرُ بهائها

حفي سلامها

ندي كلامها يسرى فى دمائكَ

ما المنى بكفيكَ حيالها

إلا مدائنُ من وحى خيالها

شادها صبرُ انتظاركَ

اه ِ لو كنتَ تعلمُ أنها

وهبتكَ أعظمَ سرها

من حور ِ الجنان ِ كأنها

أو أنها

من قبيل ِ الملائكة

الأنَ تسطعُ فى سمائكَ

شمسُ المدارات ِ الجديدة

ِتعبرُ خط استوائكَ

لتهديكَ امراءةً

تشعلُ النارَ

وتزهو بانتمائكَ

زاهر عثمان الطاهر

The US government pledges large funds for neglected tropical diseases

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Wed, 02 Apr 2008 08:16:05 PDT

The director of the World Health Organisation (WHO) has welcomed the recent announcement by the US administration "to vastly increase funding for the integrated treatment of seven of the most important neglected tropical diseases: lymphatic filariasis, schistosomiasis, blinding trachoma, onchocerciasis, and three soil-transmitted helminthiases". The US government has indeed pledged 350 million US dollars over five years to treat these diseases. A "mass-prevention" approached, similar to immunization campaigns, is likely to be adopted in order to control these diseases.

http://www.who.int/mediacentre/news/statements/2008/s03/en/index.html

The term "neglected diseases" has been coined by public health specialists/activists as an expression of their growing frustration (or even anger) at the extreme lack of attention paid to diseases afflicting poor people in the third world. The harsh reality is that giant pharmaceutical companies are not usually enthusiastic to develop drugs for these diseases as the vast majority of countries where these diseases are endemic can not afford the cost of their drugs. Furthermore, the current intellectual property regulations bar other companies from producing cheaper generic versions of the drug concerned.

The leading medical charity Médecins Sans Frontières (MSF) has been campaigning to improve access to essential drugs in resource-poor settings as well as exerting pressure on the pharmaceutical industry to facilitate production of cheap generic medicines.

http://www.accessmed-msf.org/

Suspected Whooping Cough Outbreak in West Darfur

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Sat, 09 Feb 2008 06:26:13 PST

There are strong suspicions of an outbreak of whooping cough (Pertussis) in a rural area in the western part of the war-torn region of Darfur. MEDAIR, an international medical NGO, has reported at least 147 cases from the region. MEDAIR has also reported major difficulties impeding their efforts to provide basic healthcare access to those affected.

Whooping cough is a vaccine-preventable infection that usually affects children and can cause life-threatening illness. However, in the Darfur situation the adult population will also be at risk of the diseases owing to poor coverage of routine immunization programmes during the pre-conflict era. The escalating conflict in neighbouring Chad may add further insult to injury by disrupting humanitarian aid efforts.

Whooping cough outbreaks are no stranger to the Sudanese people as the last documented epidemic occurred in southern Sudan in 2003 in the Equatoria state during the civil war.

Click on the link below for further information.

http://www.irinnews.org/Report.aspx?ReportId=76583

Rift Valley Fever: have we really seen the back of it?

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 28 Jan 2008 04:01:54 PST

WHO has released a report on 22/01/08 on the current Rift Valley Fever (RVF) situation in Sudan. It appears that the epidemic is waning with only one region (Gezira state) reporting new cases in 2008. In total, 698 cases have been reported from 6 states (Gezira, White Nile, Kassala, Sennar, River Nile and Khartoum) up until 15 January 2008. The overall case fatality rate (CFR) was 32.4% (222/698). Interestingly, some patients had occular manifestations (inflammation of the back of the eye, which can lead to blindness), a clinical finding reminiscent of the previous RVF outbreaks in Egypt in the 1990s and 1970s. For full WHO press release, please go to

http://www.who.int/csr/don/2008_01_22/en/index.html

Al-Saddiq Al-Raddi: A leading Young Sudanese Poet

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Tue, 15 Jan 2008 05:32:05 PST

Al-Saddiq Al-Raddi is a young poet from Sudan whose "imaginative approach to poetry as well as the delicacy and emotional frankness of his lyrics" earned him a leading position among Arabic-speaking poets. I still have vivid memories of him dating back to the time when I was a student listening to his poetic readings. Al-Saddiq comes across as a shy person but he never fails to capture the imagination of his audience when he starts reciting his poems . He has so far produced the following collections: Songs of Solitude, The Sultan's Labyrinth, and The Far Reaches of the Screen.

His works have been deservedly celebrated by the School of Oriental & African Studies (SOAS). Below is an example of one of his works:

لهاثْ
كأنَّها تَقتربُ من الباب

تسمعُ دقات قلبِكَ

و كأنك في انتظارِها

تَحْضُر طيورُ الضُّحى وتَصْطَفُّ على النافذةْ

........

ساعةٌ من الصَّبرِ

غابةٌ من الهديلِ والشقشقةْ

Breathless

Your heart thumps —

as if she were already at your door.
Or — as if expecting her —

all the birds in the midday sky

arrive to clamor at your window.
****
An age of patience.

A forest of fluttering.

(Translation By: Sarah Maguire)

For further examples of Al-Saddiq Al-Raddi's poems, please click on the link below

http://www.poetrytranslation.soas.ac.uk/poets/index.cfm?type=1&poet=19

Al-Saddiq Al-Raddi was also interviewed by the Guardian newspaper. To read the full interview, please click on the link below.

http://books.guardian.co.uk/poetry/features/0,,1889574,00.html

The bird flu threat

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Thu, 10 Jan 2008 02:48:10 PST

Egypt has recently declared 43 confirmed human cases of Avian Influenza (deadly strain H5N1) with 19 reported deaths. This news has alarmed the public in Sudan. Poultry producers were particularly upset as they saw consumers confidence in their products take a deep nose dive!

The public in Sudan has recently been concerned about the Rift Valley Fever outbreak and this has resulted in an unprecedented demand on poultry as an alternative to red meat products. This has certainly inflicted hardship on beef and lamb producers and it seems it is now time for poultry producers to feel the heat.

The news of bird flu in neighbouring Egypt leaves Sudanese consumers bewildered as they feel they are between a rock and a hard place. The public relations damage caused by the Rift Valley Fever saga makes it difficult to restore public confidence in official statements. It seems that becoming a vegetarian might be an attractive option in Sudan these days!

So far, there have been no reports on bird flu cases in Sudan by WHO or local authorities.

http://www.who.int/csr/disease/avian_influenza/en/index.html

A special moment

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Sat, 09 Feb 2008 06:31:34 PST

بطاقة دعوة .... معرض فنان .... ورقة ، وفرشاة ، وألوان . أحاول ُ رسم

تفاصيلك ِ الدقيقة: عيناك ِ لحظة الألق ... أنفاسك ِ ساعة الغرق ... يداك ِ آن

الحسم ِ وساعة القلق ... والشامة الصغيرة .. البسمة النضيرة .. والمشية

الوئيدة عندما يعتدل ُ المزاج . تتمازج ُ الألوان .. ترسم ُ فتاة ً خلاسية تحكى

حلما ً عن بركان ... عن لحظة أمان ... وعن

(postcard painted by the Sudanses artisit Islam )

A sip of memory nectar!

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 24 Dec 2007 09:53:51 PST

رشفة من رحيق الذاكرة

(١)

عند ما التقينا للمرةِ الأولى

سرى ذلكَ الشئُ الذى نحسهُ ولا نعرفه

اشتعلت عيناىَ بالدهشة

تلون وجهُكِ طيفاً يحبذ البنفسج

وذابَ فوقَ شفاهنا الكلام

(٢)

نهز الأنَ جذع اللغةِ

فتساقط علينا حدائقاً من الصدق

لألئا ً من الشعر تقرؤنا السلام

عليكم السلام

الجو ابتسام

العيونُ تومضُ بالبريق ِ المستهام

وفجأة ً يسرى ذالكَ الشئُ مرة ً أخرى

يسودُ الصمتُ برهة

ثم تورق أزهارُ الكلام

فنعودُ نثقلُ مائدة َ الحديث ِ بأنخاب ِ الهوي

وفاكهة ِ الهيام

زاهر عثمان الطاهر

Further twists in the story of Rift Valley Fever!

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 24 Dec 2007 14:19:44 PST

The Sudanese Ministry of Animal Resources announced today that Sudan is free from Rift Valley Fever (RVF) as per a testimony by a visiting team from South Africa. This comes immediately after the Federal Ministry of Health (FMoH) declared that 200 people have died from RVF so far and that more than 600 cases were reported in Gezira, Sennar, White Nile and lately River Nile states.

I was not particularly surprised by the announcement made by the Ministry of Animal Resources as they have been stubborn in their denial of RVF. What I am concerned about is the barrage of conflicting messages sent by the FMoH and the Ministry of Animal Resources. Furthermore, a fatwa and counter-fatwa war has erupted among religious scholars as to whether it is appropriate to slaughter animals for Eid Aladha.

I really feel that our people in Sudan deserve better!

Rift Valley Fever (RVF): the story so far...

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Thu, 13 Dec 2007 13:54:17 PST

Unfortunately, the government of Sudan continues to drag its feet on the issue of Rift Valley Fever (RVF) outbreak in central Sudan. The latest news from Khartoum paint a bleak picture in terms of lack of transparency as the government continues to send mixed messages to the public. It appears that the Ministry of Animal Resources has finally admitted the existence of the outbreak after 6 weeks of denial in a futile attempt to protect the interest of a handful of livestock exporters.

The outbreak news were first broken on the WHO website on 05 November 07. They said that they received a request from the Sudanese Federal Ministry of Health on 18 October to investigate an outbreak of haemorrhagic fever in the White Nile, Sennar and Gezira states. Appropriate samples were sent to a WHO collaborating laboratory based in Cairo (US Naval Medical Research Unit - NAMRU), and a confirmation of the virus responsible for RVF was made. The FMoH appears to have accepted these results but officials in the Ministry of Animal Resources kept denying RVF and subsequently decided to send further samples to a reference laboratory in South Africa hoping against all odds that the results might reveal something else. Some overzealous officials were thinking ahead of themselves and went to the press and announced that the Sudanese livestock is free from RVF even before the samples had arrived in South Africa. Anyway, these samples took a long time before they finally arrived in South Africa and to cut a long story short they, to the embarrassment of the Ministry of Animal Resources, also confirmed RVF virus.

This massive delay in accepting that we have a problem with RVF has devastating effects on the credibility of the government of the day in Sudan. Major livestock importers in the Gulf region will, of course, listen to reputable and credible bodies like WHO and will not wait for vague and long-winded answers from a bunch of incompetent officials who did nothing but dither around and therefore put the lives of the people of Sudan at considerable risk. Moreover, some officials tried to falsely reassure the public by saying that all livestock will be vaccinated against RVF- exactly the WRONG measure to take in an epidemic situation as this will only augment the transmission of the RVF virus! (see fact sheet from WHO below).

It is saddening but also heartwarming to hear that the people of Sudan have decided to take their own precautionary measures (although extreme in some situations). Our people have been massively let down by the government of the day. With Eid Al-Adha (Muslims Festival of Sacrifice) coming up in a few days time, I wish to hear President Elbashir saying he will sacrifice on behalf of all the Sudanese nation by slaughtering one sheep (which has been properly tested) in order not to exacerbate the current situation. I know for sure that a lot of people in Sudan have wisely decided not to slaughter animals on this occasion on health and safety grounds. An outspoken politician from SPLM was reported to say that the government appears to value animals more than humans in Sudan!

In terms of why this outbreak has occurred in Sudan, there are suggestions that climate change in the Horn of Africa might be responsible for optimizing the habitat for the virus and its vectors. Recently, a large outbreak was reported in north east Kenya in the period between December 06-April 07 and the most significant environmental factor was a sharp increase in annual rainfall. The first alarming signs have been an increase in deaths and abortions among livestock with humans in close contact (usually shepherds or vets) falling sick with unexplained illness. In terms of other outbreaks in the region, Tanzania, Somalia, Yemen, Saudi Arabia, and Egypt have all suffered significant outbreaks over the last 30 years. Interestingly, it took Saudi Arabia 48 hours to confirm the outbreak in 2000 (Madani T et al, 2003. CID, 37: 1084-1092) while it took our officials more than 48 days to quietly admit RVF outbreak!

Finally, just a few words on RVF. This is an acute viral illness that can cause a spectrum of disease in humans ranging from flu-like illness to fatal bleeding. Other forms of the illness can manifest itself as retinitis (inflammation of the back of the eye), meningio-encephalitis (inflammation of the brain and its surrounding layers), and hepatitis (inflammation of the liver). Transmission to humans usually happens through close contact with sheep, cattle, and other animals as well as by being bitten by insects such as mosquitoes which took a blood meal from an infected animal. There is no documented human to human transmission of the RVF virus but specific treatment is lacking once the virus infects humans. Furthermore, there is no evidence that vaccination is effective in human beings, unlike the situation in animals.

I do hope that lessons will be learned from this epidemic despite that fact that this came about the hard way. I sincerely hope that someone somewhere in the FMoH is looking at the standards of care that patients with RVF received as well as documenting their clinical characteristics and outcomes. I also would like to pay tribute to those who succumbed to RVF (161 people died out of 436 according to WHO figures). I pray for them and their families to be blessed by the mercy and compassion of Allah.

The links below take you to a leaflet produced by FMoH & WHO in Arabic, the WHO fact sheet on RVF as well as their latest press release on the RVF situation in Sudan.

http://www.who.int/csr/disease/riftvalleyfev/RFVleafletFMOH.pdf

http://www.who.int/csr/don/2007_11_22/en/index.html

http://www.who.int/mediacentre/factsheets/fs207/en/index.html

WHO reports 91% fall in measles deaths in Africa

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Thu, 13 Dec 2007 13:08:00 PST

The World Health Organisation released a report on Progress in Global Measles Control and Mortality Reduction (2000-2006) in its bulletin the Weekly Epidemiology Report. This report indicated that mortality from measles has fallen by 91% in Africa. Other parts in the world have reported a similar trend with the exception of the Indian subcontinent in which a far smaller mortality drop of 26% was reported.

The findings of this report confirmed improved coverage of routine immunisation programmes and further support WHO strategies of targeted campaigns to ensure that children had a second chance to be vaccinated.

http://www.who.int/wer/2007/wer8248.pdf

Comment: The above report appears too good to be true, at least for me. Maybe I have become a natural skeptic but here you go. Remember, this report came out a few days after WHO revised its figures on HIV/AIDS prevalence and thus revealing that the methods used early on were not as rigorous as one would expect them to be.

A moment of despair

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 24 Dec 2007 09:36:53 PST

لحظة يأس

لا شئ يستحقُ الأنَ كل هذا الأرق

كل هذى الثوانى المستبداتِ عذاباً وقلق

شمسكَ التى كانت

استدارت

ثم خانت حمرة الشفق

لأجل حفنةٍ من ورق

لا شئ يستحقُ الأنَ كل هذا الرهق

زاهر عثمان الطاهر

Repeated patterns

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Thu, 13 Dec 2007 13:43:56 PST

Square, triangle, hexagon, and so forth ...

Thanks to my little co-editor Sarah!

The last song

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 24 Dec 2007 09:49:29 PST

الأغنية الأخيرة

صدئت حنجرةُ الغناء

والكلماتُ الندية

ضلت طريقها فى دهاليز البكاء

أزهر الحزنُ بعدكِ موسمين للشتاء

حين ضاع القلبُ بين فواجع النهاياتِ وأصداءِ الإبتداء

يا قافيةََ الرجاء

أنكر البحرُ زرقتهُ

وانحسرت عن حضنِ السواحلِ أمواج الإشتهاء

لم يبقَ - مليكتى - غيرُ زبدكِ الذاهبِ جفاء

غيرُ الصدأ يعلو حنجرةَ الغناء

******

كل الأشياءِ تحاصرنى بكِ

عطرُ البهجةِ

زهوُ اللحظةِ

واحتفاءُ المكان

كل السعادةِ تورقُ من ذكراكِ ، والأحزان

نصبت سرادق الكلمة

كل الحروفِ احترقت عشقاً

كل المشاعرتوهجت صدقاً

أفاضَ الألقَ مذاباً

على نقوش الهوى و تذكاراتِ الحنان

فخُذِى ما استطعتِ من ذكرى وارتحلى

فمنذُ الأن

لا دمع يطفئُ لهيبَ الشوقِ والحريق

ولا الوهمُ الراكض فى مداركِ يعاودهُ البريق

وهاهى الحقائقُ من سباتِ الأمانى تفيق

تلدُ شمساً تخوضُ أبحرة الضباب

تعُبُ الملحَ

تنكأ الجُرحَ المصلى فى العيونِ البلوريةِ النقاء

يتوضأ الصبحُ

يُغرقُ الحروفَ فى مقاماتِ الدعاء

تتصدعُ الحناجرُ بالغناء

ترددُ اسمكِ الوضاءَ أطيبَ الأسماء

فخُذِى ما استطعتِ من ذكرى وارتحلى

يا أروعَ روائع الأشياء

زاهر عثمان الطاهر

Antibiotic use in Sudan: An alarming situation

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Thu, 13 Dec 2007 13:08:00 PST

According to Alsudani newspaper (06 Dec 07; issue 740), a survey conducted on behalf of the Federal Ministry of Health revealed that 68% of respondents in 5 states (Northern, Gedaref, Khartoum, White Nile, and Northern Kordofan) had inappropriate antibiotics prescribed. Moreover, 48% used unsafe injections. Overall, 40% of respondents did not use antibiotics correctly.

Comment: It is not clear how representative this sample was. Furthermore, the terms used in the report were loose and therefore I did my best to try and infer what they possibly meant by them. A final thought, I wonder whether there is actually any active role or support for clinical pharmacists (if they exist) to ensure rational drug prescribing as well as safe use. As I far as I know, anybody can walk into any pharmacy and buy whatever medication they wish. It is equally true to say that any doctor of any grade or expertise can prescribe any medication at any dose without having the safety net of a qualified pharmacist checking that. Below is the Arabic version of the article by Alsudani newspaper.

إدارة الصيدلة تحذّر من سوء استخدام المضادات الحيوية

الخرطوم: إبتسام حسن

كشف بحث أجرته إدارة الصيدلة الاتحادية عن قياس مؤشرات الاستخدام الرشيد للدواء في المرافق الصحية العامة شمل (5) ولايات وأن %68

من السكان يستخدمون المضادات الحيوية استخداماً غير رشيد. وحسب منظمة الصحة العالمية ان لا يتجاوز الاستخدام غير الرشيد

نسبة الـ(30%).وحذرت نتائج البحث من سوء الاستخدام غير الرشيد للمضادات الحيوية الذي يؤدي لمقاومة المرض ويؤثر على الصحة

والاقتصاد، مؤكدة ان استخدامها في الولايات الشمالية أعلى من نسبة (90%).وقالت مسؤولة الاستخدام الرشيد للدواء بإدارة الصيدلة د. غادة عمر ان استخدام الحقن بطريقة غير رشيدة نسبته عالية حيث وصلت إلى (48%)، وحسب منظمة الصحة العالمية من المفترض أن تكون أقل من (20%)، واضافت ان (40%) من المرضى لا يعرفون استخدام الدواء، ودعت إلى ضرورة وضع المعالجات اللازمة للاستخدام الرشيد، مشيرة إلى القوانين والتشريعات التي تمنع صرف الدواء.واوضحت د. غادة عمر ان البحث الذي استهدف (5) ولايات هي؛ الشمالية، القضارف، الخرطوم، شمال كردفان والنيل الابيض يهدف لمعرفة مدى الاستعمال غير الرشيد عند الاطباء والصيادلة والمرضى.

To Sami and others

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 24 Dec 2007 12:22:23 PST

إلى سامى ،....، وأخرين

بالأمس، يا حديقة الشذى، كانت السماء مزركشة

النجيمات كانت فى أنسها الليلى

والغيمات ذابت مطراً رذاذ

وكنتَ تختال ضاحكاَ

بين نجمةٍ مغازلة وزهرةٍ موشوشة

أهداكَ القمر قنديلاًَ

وإزميلاً

وفرشاة

ومحبرةً تنسكب أطفالاً رائعين

وروداً ورياحين

كانت أيامك مثقلةً بالرضى

كانت بحقٍ مدهشة

وكنت حينها أمان الخائفين

حنان البائسين

يا أيها المحبوب والمغضوب عليه بعد حين

حدثنى عن أحبابك

عن مصابك

عن الحزن ساعة حط رحله ببابك

فأقفر المكان

حدثنى عن الخذلان

وكيف صارت دنياك موحشة

عن النصل ساعة قد ظهركَ واستطاب

تغور الجرح المزلزل جأشكَ بالعذاب

يا سيدى

عبثٌ مرضاةُ الأحباب

عبثٌ تلهفُ اللقيا

سرابُ السقيا

واحتراقُ الأعصاب

عبثٌ هى مرضاةُ الأحباب

زاهر عثمان الطاهر

Academy for Infection Management (AIM)

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Tue, 15 Jan 2008 13:06:25 PST

Today, I have attended an educational workshop in Leeds organised by the Academy for Infection Management (AIM). I have been reliably told that healthcare professionals can register for FREE at their website (see below) and can therefore access various resources including teaching slides on infection, core references, and summary of published treatment guidelines on infection. I should make it clear that AIM is sponsored by AstraZeneca.

http://www.infectionacademy.org/

Former UN special envoy for HIV/AIDS in Africa launches a scathing attack on UNAIDS

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Thu, 13 Dec 2007 13:08:00 PST

UNAIDS has released revised figures on HIV/AIDS on 24 November 07 which estimated the number of people infected by HIV/AIDS to be 33 millions rather than the previously accepted figure of 40 millions. Professor Stephen Lewis, the former UN special envoy for HIV/AIDS in Africa, has severely criticised UNAIDS for being "stubborn and sloppy" in the way they combined figures for HIV/AIDS and said that the current report will help divert attention away from the "continuing apocalypse for sub-Saharan Africa" by focusing instead on the mathematical models and reasons for the adjusted figures. He also accused them of "catatonic passivity" in the face of the HIV epidemic. Here is what Stephen Lewis, the former UN special envoy for HIV/AIDS in Africa, said to the World Health Editors Network on 23 November 2007 at the Imperial College in London:

"It’s fair to say that any speech designed to address leadership and AIDS must start with the events of this week: the publication of the UNAIDS Epidemic Update, 2007. Let me get two matters out of the way at the outset. I think the new set of numbers is much closer to the truth of the pandemic, although I’m inclined to believe that they’re still too high and that another awkward revision lies ahead. Second, I don’t believe for a moment that UNAIDS inflated the figures for the purpose of extracting money. That seems to me too conspiratorial by half. If by some bizarre happenstance, Machiavelli’s apprentices were involved, they make lousy fund-raisers: we’re billions of dollars short of where we should be, old estimates or new.

I take issue with the report on different grounds. For years, knowledgeable epidemiologists have been telling the UN that the figures were too high. They did not whisper their criticisms: they wrote books and articles. They lobbied behind the scenes. No one paid them heed. It does not take a Nobel prize statistician to guess that prevalence rates based on urban antenatal clinics should not be extrapolated to the entire country and presented as holy writ. That became compellingly clear when the spate of population-based household surveys, country after country, invariably showed lower prevalence.But the UN chose a course of delay and dithering. It can never admit that it’s wrong. So finally, and predictably, came the moment of truth: the result is an overall prevalence rate that is lower by almost seven million than last year’s estimate.Sure, it can be rationalized by arguing that it’s just a methodological adjustment, rooted in superior statistical-gathering techniques. And that might even be persuasive if there had not been academicians and epidemiologists clamouring for revision for years. The UNAIDS explanation sounds good; the fine print has the ring of arcane scientific authority. But down here, in the mortal universe, where people are not easily taken in, it does not wash.

The UN was stubborn and it was sloppy. In the process, it undermined public confidence in the reliability of the figures, introducing completely unnecessary levels of doubt, contention and confusion.Where HIV/AIDS is concerned, there is no room for the jolting of confidence. The new estimates confirm a continuing apocalypse for sub-Saharan Africa: 22.5 million infections, 61% of them women, 68% of world-wide infections, 76% of all deaths, 11.4 million orphans … this is where the focus must be, this is where it should always have been; not a report cluttered by mathematical adjustments so that virtually every story that’s written begins with the news of a statistical volte-face. If the recording of data had been more scrupulous all along, we could have welcomed this report as the latest instalment in a record of declining numbers, showing some strong hints of progress, and plausibly leading to universal access for treatment, prevention and care by 2010.Instead, all of us have to run to the trenches to remind the world that more money is still desperately needed and that the situation, in many places, remains grim, bleak, funereal.

As a matter of fact, at the risk of knocking the nail through the wall, allow me to add that I earlier used the word ‘sloppy’ advisedly. For a number of years in the 1990’s, I was the Deputy at UNICEF and oversaw a raft of publications. I would never have permitted this Update to go out as is. Let me explain by way of example. In one of the dense explanatory notes, there’s a statistical adjustment described that attracted little notice, but seems to me to be of enormous import. If I may attempt a straightforward simplification, the report seems to be saying that, on average, the population-based random household surveys in countries with generalized HIV epidemics produced estimates that were 20% lower than the estimates produced by antenatal surveys. Therefore, says the report, for all those countries with generalized epidemics that have not yet done random surveys, we’re applying a reduction factor of 0.8 … that is to say, the new figures will be 80 % of the old figures. That’s quite a reduction!

Don’t you think it might have been useful to produce a table (there were, after all, tables galore) to show what it might mean, in practice, country by affected country? No such luck. Instead, the report notes that “Of the total difference in the estimates published in 2006 and 2007, 70% are due to changes in six countries: Angola, India, Kenya, Mozambique, Nigeria and Zimbabwe.” I was stumped by Angola because its prevalence rate is so low, it’s hard to imagine that it could make a great difference to the numbers. India everyone knows about. Kenya and Zimbabwe have oft been talked about (although the alleged decline in Zimbabwe seems to me to be complicated by the numbers of deaths, the out-migration, and the difficulty of reliable surveys in a sociological wasteland). Nigeria was clearly possible. But Mozambique was a mystery because I remembered from my last visit that the most recent data had shown an increase in prevalence.This is no small matter. This is a report that is telling the world that the dramatic revision in the figures, and the figures themselves, are now the best that science has to offer.Naturally, therefore, I looked at all the entries in the report dealing with Mozambique. On page 12, there is a section on “Recent HIV and sexual behaviour trends among young people” that chronicles reductions in HIV prevalence in various countries from Kenya to Malawi to Zimbabwe to rural Botswana. However the paragraph ends with these words: “There was no evidence of a decrease in HIV infection levels among young people in Mozambique …” (emphasis mine).

On page 13, there’s an elaborate table titled, in part, “2006/2007 analysis of trends among 15 to 24-year-olds in high prevalence countries: HIV prevalence among pregnant women, 2000-2006 in sentinel surveillance systems …” Mozambique is in the table. Below the list of countries, there’s an asterisk which reads: “Analyses of countries with more than three years of data based in the following number of consistent urban and rural sites …” For Mozambique there are 20 sites listed, South, North and Central. Beside Mozambique is another legend symbol which reads: “No evidence of decrease” (emphasis mine).

On page 15 we encounter the critical “Regional Overview”, leading with the section on “Southern Africa”. It indicates that this sub-region includes the eight countries with prevalence rates over 15%: Botswana, Lesotho, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. The narrative then points out, with some gratification, that in Zimbabwe there is an actual decline in national HIV prevalence, and that “the epidemics in most of the rest of the sub-region have either reached or are approaching a plateau” The next sentence reads: “Only in Mozambique latest HIV data (in 2005) have shown an increase in prevalence over the previous surveillance period.” (emphasis mine).

Finally, on page 17, Mozambique is dealt with separately, as are all the countries of the sub-region. The opening paragraph reads “In the other lusophone country of this sub-region, Mozambique, the epidemic has again started to increase in all three zones after appearing to have stabilized in the early 2000s.” (emphasis mine … the three zones are south, central and north, and the other lusophone country is of course Angola).

If I was in the Ministry of Health in Mozambique, I would want to know why all of the narrative evidence of the report seems to contradict the assertion that Mozambique is one of the six countries in the world that has most significantly contributed to the reduced numbers, 2007 over 2006. And if the explanation is --- as it must be --- the application of the new 80% rule applied to countries, i.e Mozambique, that haven’t yet done population-based surveys, then those figures should be set out conclusively. Otherwise this report does what so many other reports have done: it slides casually over critical information. It confuses where it ought to be clarifying. It’s blurred where it should be coherent.For me, the Epidemic Update, 2007, is simply a symbol, a symbol of insufficient leadership, within the United Nations, against the pandemic of AIDS. The time has come --- we’re just a week away from another World AIDS Day --- for the new Secretary-General to throw the full weight of his office behind a campaign to subdue the pandemic, with a particular consuming focus on Africa.The agenda lies in the UNAIDS report. For example, one of the most startling statistics is the revelation that women now constitute 61% of the infections in Africa … close to 14 million women infected. There are no words. It’s a catastrophe rooted in gender inequality, and everyone in the highest citadels of the United Nations knows it, but virtually nothing changes.

We have a report from a High-Level Panel on UN Reform, pointing out the lamentable UN record on women, and recommending the creation of a new international agency for women. The proposal lies dormant on the order paper of the General Assembly, crying out for leadership from the Secretary General. The Deputy Secretary General has spoken, strongly and bravely although, given the inevitable and nasty internal rivalries, her words are too often given to rhetorical sleight-of-tongue.Where is the UN Secretary General when the AIDS pandemic rages, and the women of Africa need him most? No one pretends that the women’s agency is the sole answer, but you can bet that things would not be so excruciatingly horrendous if women had an international vehicle to draw upon, with resources and voice. So, too, women in conflict zones.

My colleagues and I carefully watched the Security Council debate on Resolution 1325 just a couple of weeks ago, and have read carefully the proceedings of the Security Council debate this week on the protection of civilians in armed conflict. The speeches are getting better: more feeling, more informed, more urgent (that is particularly true of the Undersecretary General for Humanitarian Affairs; on the other hand, the Secretary General’s speech last Tuesday on the protection of civilians in armed conflict was so proforma as to make one weep. He managed to mention Sudan, Somalia, Afghanistan, Iraq and a passing aside to Darfur. Not a syllable on the Democratic Republic of the Congo). When you have a savage war on women, as in the DRC, with huge implications for transmission of the AIDS virus, speeches are the road to hell. When will the United Nations actually take hold? There are suggestions cited of the Secretary General leading a new campaign to eliminate violence against women. I recently saw an early draft of this potential Secretary General initiative, and I can categorically say that in more than twenty years of association with multilateralism, I have rarely seen anything more vapid, fatuous and insubstantial. It was as if the illusion of progress, dressed up in the Byzantine underworld of United Nations processes was sufficient unto itself. Public relations for inconsolable grief.

The Epidemic Update report acknowledges that only in a few instances has behaviour change played a serious role in the reduction of the numbers. In fact it says that the differences in estimates “result largely from refinements in methodology rather than in trends in the pandemic itself.” There is no question that a small proportion of the decline stems from changes in behaviour, but there is equally no doubt that the vast majority of the difference lies in the methodological adjustment.Now, then, is the perfect time to rally the UN community to the side of prevention, with much greater focus on high-risk groups; on the increasingly persuasive thesis of concurrent partners; on the roll-out of male circumcision (which should have been pursued vigorously much more quickly, but like so much else in the response to the pandemic got caught up in the overweaning proclivity for excessive scientific inquiry when the case is already clear, not to mention the faint hearts in the face of potential controversy); on harm reduction around which there has been inexcusable ambivalence; on the Prevention of Mother to Child Transmission, possibly the easiest preventive intervention of all, and therefore the most grievous emblem of multilateral negligence; on the absolute, resolute need to pursue, with unflinching tenacity the continued quest for a microbicide and a vaccine, regardless the setbacks. This is the time for a crescendo of United Nations voices.

The Epidemic Update is also shocking in the information that 76% of the overall deaths lie in Africa: one million, six hundred thousand adults and children. It tells you everything you did not want to know about the painfully slow roll-out of treatment, and how vital it is that keeping people alive not get lost in some senseless, artificial tension between treatment and prevention. Nor should we ever forget where so many of the deaths come from, and how silent were the voices of the United Nations leadership while President Mbeki pursued his fatal denialism. South Africa has far and away the highest number of HIV infections in the world: five and a half million. There are eight hundred to a thousand deaths a day. No one has ever been held to account. Talk about impunity. And as always, there’s the question of resources. It’s hard to know how the donors will react to the new numbers published by UNAIDS. They may simply yawn, and give whatever they intended. They may feel bamboozled, and want to cut back. They may see possibilities in the reduced numbers, possibilities of greater progress because fewer people are involved. Whatever the reaction, we must somehow persuade the world that we’re way behind, billions and billions of dollars behind, when it comes to funding all the components of the pandemic, from orphans to second-line drugs.

All of these elements, so many of them flowing generically from the Epidemic Update, are the stuff of the United Nations. UNAIDS, the Joint UN Programme on HIV/AIDS, oversees or coordinates ten co-sponsors: UNHCR, UNDP, UNICEF, WFP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. That’s a compendium of multilateral aristocracy and power rivaled in influence only by the G8 and the International Financial Institutions. And yet, members of the UN family, in the face of the AIDS pandemic, have sometimes acted with a kind of catatonic passivity. There is no excuse for it.

More than twenty-five years into the pandemic, we have an epidemic update that is --- let’s face it --- horrifying in its implications. Whether it’s 40 million or 33 million, this plague continues to ravage humankind. I simply do not believe that the United Nations has done everything it can possibly do to turn the tide. And I don’t mean just the member states, I mean the agencies and the secretariat. I’m a multilateralist to the core of my being. But that does not mean that the UN is above criticism. And it most emphatically does not mean acting as an apologist for those who are chosen to lead and who have failed to lead."

Old Sorrows

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 24 Dec 2007 12:24:46 PST

أشجان

كان المساء خريفياً باهتاً

وكانت السماء تمطر شجناً بقلبى

فتنهكنى

وكنت وحيداً أتسكع فى طرقات المدينة

أسيان أتسول الحب

و أشتهى طعم السكينة

كانت الريح تصفر لحناً حزينا

والحدائق تفوح بالتواطؤ

وتبذل نفسها للعابرين

تحاصرنى وجوه الشامتين الصامتين

والخائنين الساقطين

والمحبين السفلة

تغلق المدينة دونى أبوابها

تطلق صوبى كلابها

فأمضى شاهراً حزنى

أتقيأ خيبتى

أتعثر بمشيتى

ألوح بقبضتى

ألعن المساء

وأعلن ثورتى

زاهر عثمان الطاهر

The dark ages

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Mon, 24 Dec 2007 12:26:24 PST

جاهلية

إنا يا هندُ، برغم الوهج الزائف، عمياوان

تملؤنا الدهشة إن صدئت أفواه الأوثان

نئد الأيامَ ولا خمرَ تسكت أو تدنى النسيان

الصحو بمكةََ يفضحنا

يحيى الأحزان

أشتاق إلي زمنٍ

يأمن فيه من يدخل دار أبي سفيان

المعلي حامد صالح

El Mala Hamid Salih has an outstanding poetic talent. He gives you the feeling that he truly writes his poems with soul and blood and you can only applaud him in great admiration!

Beyond any words

zahir_babiker@yahoo.co.uk (Zahir Osman Eltahir) — Tue, 18 Dec 2007 05:11:45 PST

أكبر من كل الكلمات

يا هذا السنا الدفاق

إمسح عن عيونك دمعك الرقراق

وارحل عن مدائن الأحزان

فهاهى ذى قوافل الأشواق

تنيخ لك أعذب القصائد

تغيب الكلمات فى وهج الرؤى

وتحلى زمانك بأجمل القلائد

يا نغما على وتر الشوق عائد

القلب يشتهيك

يشتهى سحرك الأخاذ

عطرك النفاذ

وكل الألق الساكن فى العينين

يا زهواً نثر الحرف صبابة

ذوب الوجد شعراً ينسج الحب كتابا

إجعلنى أخرج رؤاى الحالمات من شرانق المخافه

وأغنى....أنفر الحروف ثقالاً و خفافا

كى توقع الألحان سحراً يسرى فى النفوس رهافه

وانظر إذ نغيب فى نشوة السلافه

كيف نمجد من نهوى

من يملك القلب أذيناً وبطيناً وشغافا

زاهر عثمان الطاهر

These verses, which I wrote many moons ago, evoke wonderful memories in my mind. They date back to the good old days at university in Sudan. I would like to dedicate this piece to all veterans of Gezira University.. To those still at home in Sudan struggling to make ends meet. Also, I would like to dedicate them to those fellows who spilled -just like a bag of beans- all over the world and became part of the wide Sudanese diaspora!