Sunday, 28 September 2014

The NDC & NPP Must Stop Kowtowing To Vested Interests

Having both been in power for at least a minimum of two consecutive 4-year terms each, what conclusions, if any, can one draw from the years during which the governing National Democratic Congress (NDC) and the party that formed its predecessor regime,  the New Patriotic Party (NPP), have ruled Ghana?

For a start, it is obvious that the need for funds to run them, makes both parties beholden to  vested interests - yet the sole purpose of vested interests in our country, as we all know, is to participate in the brutal gang-rape of Mother Ghana.

It is also a fact that buying off those who seek to protect the national interest, at any given point in time, is what enables vested interests in our country to achieve their goals - and maintain their iron-grip on our nation.

 That is how come the same people who virtually crippled Intercity STC during the Kufuor-era, by foisting untested and unsuitable Chinese-made FAW buses on the company, are repeating their super-lucrative trick - this time lumbering Metro Mass Transit Limited with Chinese buses: at the outrageous profiteering-price of a staggering US$200,000 each.

The many logic-defying laws passed by Ghana's Parliament over the years - laws clearly detrimental to our country - also  remain eloquent testimony to the power of vested interests in Ghana.

The sale and purchase agreement for VALCO to a non-existent joint-venture, International Aluminium Partners (IAP), during the NPP's period in office is another egregious example of the shenanigans of vested interests.

In that instance, the Norwegian company Norske Hydro and the Brazilian firm VALE, both strenously denied ever agreeing to purchase VALCO in a joint-venture. Yet vested interests somehow succeeded in having that fraudulent agreement railroaded through Parliament,

Clearly, in order to rid political parties of the baleful influence of vested interests, there is a need to lift the veil of secrecy surrounding their sources of funding.

As long as both major parties are secretive about their sources of funding,  they will continue to remain vulnerable to the  blandishments of the powerful few with greedy ambitions - who actively participate in the rip-off of our nation - and  corruption will consequently remain endemic in Ghana.

That is why those ultimately responsible for the GYEEDA, LESDEP, SUBAH and SADA scandals appear to be beyond the reach of the laws of our country - whiles smaller fish are used as scapegoats by being tried: as a sop to public opinion and to placate critics of the government.

Let the men and women of goodwill in all the  political parties in our country address this central problem of our nation's politics.

It is a problem that must be confronted if we are to rid Ghana of high-level corruption. As things stand, it does not matter whether it is the NDC or NPP that is in power: alas, corruption will continue to hold back our nation from moving forward - and living conditions for ordinary people will continue to remain harsh and unbearable.

Perhaps the question we must pose is: if, after lengthy periods in power, there has been precious little improvement in the lives of ordinary people in Ghana - particularly those from the base-of-the-pyramid demographic -  what does that tell us about the ability of the NDC and NPP to resolve the problems that confront ordinary Ghanaians?

 It is time ordinary people understood that if the two biggest political parties in Ghana continue to be beholden to vested interests, they will continue to pay lip service to ensuring the well-being of our nation and promoting the welfare of ordinary people - and focus instead on serving their selfish and ruthless paymasters.

It is the power exercised by vested interests, for example, that is responsible for Ghana signing the world's worst oil agreements with foreign oil companies.

The painful truth is that if we are to see an improvement in living conditions for ordinary people in Ghana, the NDC and NPP must be forced to stop kowtowing to vested interests. Failing that, perhaps Ghanaians would be wise to turn to other political  parties instead, in the December 2016 presidential and parliamentary elections. A word to the wise....

Thursday, 25 September 2014

Ghanaian Healthcare Professionals Must Be More Compassionate Of The Poor

Why I'll risk my life for Ebola patients

Cokie Van Der Velde in 2012
Hundreds of foreign aid workers are in West Africa treating people with Ebola. One of them is Cokie van der Velde who has just flown from the UK to Liberia. She explains why she has left the safety of her home to face the deadly virus.

I was first in Liberia five weeks ago and I believe the situation is now much worse. Back then, our treatment centres had already run out of room and we were starting to put people in corridors.

In the centre, people groan and cry out - the smell of blood, diarrhoea and vomit is awful - unfortunately there is also a very pervading smell of dead bodies.

I can only leave it to your imagination to understand what a pile of bodies smells like after a week in very hot, moist surroundings - it makes you feel sick quite a lot of the time.

“Start Quote

Nobody else has been near them for days. They must feel very lonely and very frightened”
I am responsible for infection control which means that my first job is to ensure the safety of the people I work with and of myself. We have to wear our scrubs, then two or three pairs of gloves, a completely waterproof suit and a head covering, a mask, goggles and a big apron over the top.

It's incredibly hot and humid - when you undress back to the scrubs afterwards it looks like someone has just poured a bucket of water over you.

I try to go round the patients and help where I can and give them some water. I'll change and wash patients and just try and give some physical contact to each person because nobody else will touch them, nobody else has been near them for days. They must feel very lonely and very frightened.

I don't know how much comfort I am bringing to people when I'm dressed in a mask and goggles and completely covered from head to foot. If we have children at the treatment centre, which we quite often do, I'll try to bring them some toys and have a little game with them if I can.

Cokie van der Velde earlier this year in Guinea  

Cokie van der Velde also helped Ebola patients in Guinea earlier this year

Depending on how many people have died, I'll then start the very unpleasant job of moving the bodies. We put people in body bags, we write the names on the body bags and we move them to the morgue.

If the relatives want to come and see the body and say goodbye, we set up a viewing and I try to make that as pleasant as I can - if that's at all possible. I'll put flowers round the body bag and if it's a child I'll put some toys around them. I'll also put the toys in the body bag with them when we seal it up.

You can't let the relatives touch the body - they are just allowed to view it and then we seal it up forever. It's a very sad moment.
I do feel fear, I can't deny that.

Find out more

Cokie van der Velde spoke to World Update and The Why Factor on the BBC World Service
Last time I was in Liberia, sometimes I'd think, "I feel a bit feverish", or I'd wake up during the night and take my temperature. If I had a slight sore throat - one of the first signs of Ebola - I'd start to worry I had the virus.

There is always an element of risk when I work for MSF - I could be caught in crossfire, I could always pick up a nasty disease and there's the small chance of kidnap. And normally I would put that risk at about one in 1,000. So it's not that high. But I must admit, when I sat down and thought about it, I would say the risk for me now is about one in 10.

I've made sure that my will and my house and everything are in order so that if for some reason I don't come back at least it will be easy for my relatives to carry on. I have had my children, I've had my grandchildren and of course I still want to be part of their lives but it's not like I'm leaving small children behind. I think it's ok for me to go and risk my life and my family understands.
I've been doing this type of work for 12 years and they are used to the fact that I go away but this time it is more concerning for them.

Cokie van der Velde
If they don't hear from me for a while they do start to get very worried but they accept this is something I feel that I have to do and I think in a way they are a little bit proud that I'm willing to risk my own life to help others.

One of the reasons I enjoy working for MSF is the challenge. Before I started working for them, one of my passions was rock climbing. So it is probably something in my personality that makes me accept these challenges.

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It's made me think about my own death and what will happen when I die”
I go partly because of my belief that there should be social justice in the world - that there should be some sort of equality. The people I'm helping are part of the human race, part of humanity - in that respect, all people for me are the same. I feel I have as much obligation to help a stranger as I do to help someone I know.

That last time I was in Liberia I must have moved hundreds of bodies but only three people survived during the month that I was there. I don't think you can see that many bodies without viewing death in a different way.

I try to always make sure that the team I'm working with stops for a moment to say goodbye to the person before we put them in the body bag. We still try to keep a reverence for the dead. Even though I'm not religious, I hope I can bring some sort of spirituality to that moment and some respect to the grieving of the relatives.

Putting all these bodies into body bags, I sometimes can't help imagining my own body being put into one - I especially think about that in the middle of the night. It's made me think about my own death and what will happen when I die. But when you see so much death, you accept that this is really just part of life - that we live and die.

That doesn't cheapen people's lives but I think it brings home to me the reality of death, whereas in our society, or at least in my life, death is sort of ignored. It's something that happens but you keep it in the back of your mind. Now it's very much in the front of my mind and I accept that it will eventually happen, sooner or later.

I do enjoy my job, I don't think you could do what I do if you didn't enjoy your work. I can't say I particularly enjoy working with dead bodies but there's a lot of camaraderie - there's a satisfaction when you do get it right and eventually we will get this epidemic under control.

When that happens there will be great elation and the satisfaction of knowing I did a job that maybe not everyone could have done and that I played a small part in helping to overcome this.

Cokie Van Der Velde spoke to World Update and The Why Factor on the BBC World Service"

End of culled article from the BBC News website.

Monday, 22 September 2014

What Nkrumah's Detractors Fail To Recognise

On Founder's Day yesterday (21/9/2014),  it was to be expected that the achievements of Ghana's first prime minister and first president, Osagyefo Dr. Kwame Nkrumah, whose birthday we were celebrating, would be denigrated by his detractors.

It seems to escape the Professor Mike Ocquayes in our midst that almost alone amongst the politicians in the vanguard of the movement of those who wanted the British colonial regime to transfer power to the indigenous people of the Gold Coast colony, Nkrumah wanted the new post-independence polity to be a unitary state - in which there would be universal adult suffrage and  the nation's leaders would be elected by ordinary people.

Almost to a man,  Nkrumah's political opponents wanted the British to grant independence  to an entity that would be a federal state - one made up of pre-colonial tribal entities and in which the vote would be restricted to property owners and salaried workers only (the so-called 'property-owning democracy').

Naturally, the bulk of those who qualified for the vote in that federation of tribal entities would be the so-called 'intelligenstia', comprised mainly of members of the professional classes - who could mostly be relied on to keep the descendants of the pre-colonial ruling elites in power permanently: which was the whole idea for an elite that for the most part despised ordinary people.

So although it is true that a number of politicians fought for Ghana's independence - a historical fact that Nkrumah acknowledged: listing some of their names in his autobiography, and mentioning the names of others in some of his speeches on the subject -  the unitary state that became Ghana after independence was the manisfestation  of the successor-state to the Gold Coast colony that Nkrumah had envisioned during the fight for independence.

Nkrumah also virtually stood alone in clearly understanding  that by definition decolonisation could never be an amicable process in which a benevolent colonial power willingly handed over a resource-rich colony to the hitherto colonised people whose destiny it once controlled to exploit its resources for their own benefit. Nkrumah was clear in his mind that in that sense no colonial power could share the same interests as those of the people it colonised: And that ultimately it could not be well-disposed towards the colonised people either.

Nkrumah knew that for that reason independence had to be snatched from the hands of the colonial power. Most of his political opponents on the other hand naively thought the British colonial power was well-disposed towards them and could be relied on to hand over power to them amicably - and  were thereforge  willing to accept that in the final analysis the transfer of power would be on Britain's  terms.

It was a grave error of judgement and a strategic mistake. Alas, it is that selfsame naivety amongst the present crop of the political progeny of Nkrumah's political opponents of yesteryear, which is responsible for the neocolonialism that enables our resources to be pillaged by foreign commercial interests (covered by opaque legal agreements sanctioned by our self-seeking ruling elites that are detrimental to our nation).

Perhaps it might come as a surprise to many younger generation Ghanaians to discover that some of Nkrumah's opponents actually travelled all the way to London to plead for independence to be delayed - because in their view we were not ready for it. Incredible, but true.

 (Incidentally, after Ghana gained its independence, they also tried to stop U.S. government and multilateral institutional funding for the Akosombo hydropower project.  Amazing. But I digress.)

And when the so-called 'Big Six' were arrested, five of them promptly denounced the sixth, Nkrumah, to the colonial authorities - accusing him of being a communist agent. Whiles they were freed, Nkrumah was kept incarcerated.

 Nkrumah was a genuine nationalist hero who towered above his contemporaries. That is why he is the only politician of his generation to be in the Pantheon of twentieth century greats.  With respect, the verdict of  history is not obtained by revisionism  - and neither is it secured by dissimulation.

 Nkrumah had his faults. He was not perfect. But he genuinely cared about ordinary people and sought their welfare always. And he acted to protect the national interest at all material times. For example, he would never have allowed those rip-off oil agreements with foreign oil companies, which we are now lumbered with, as a result of today's high-level corruption - something that Nkrumah would never have tolerated in such an important sector of the national economy.

The failure of Nkrumah's detractors to recognise the fact that Nkrumah and his opponents sought different successor-states to the Gold Coast colony,  during the fight for independence, is the main reason why they are against him being referred to as Ghana's founder. To the extent that Nkrumah fought for a unitary republic, whiles his opponents sought a federation made up of pre-colonial tribal entities, he is definitely the founder of Ghana.

Thursday, 18 September 2014

Why Lauretta Vivian Lamptey Should Resign

At a time of austerity, in a nation in which such huge disparities in wealth exist, it is important that senior public officials are judicious in their use of taxpayers' money.

It is intolerable that huge sums belonging to taxpayers can be expended on the renting of office accommodation in expensive private properties and securing luxury accommodation to house senior public officials, as well as for the purchase of expensive official vehicles for senior staff - all of whom are already relatively well-paid as it is.

What that invariably does, is that there is very little cash left over, in the annual budgetary allocations of sundry public-sector organisations - sufficient to enable the core work for which they exist to be carried out effectively - once provision is made for payment of salaries of the rest of their staff.

One doubts very much that if it were their own private businesses, those in charge of the  public-sector entities paying such astronomical sums in rent advance - as long as three years in certain cases and amounting to hundreds of thousands of Ghana cedis -  to private landlords for office accommodation, and for rented accommodation to house senior staff, would venture to do so.

It is an egregious practise that cannot be justified under any circumstances in a cash-strapped country like ours - and it is vital that such senior public officials  set a good example, by ensuring that hapless taxpayers get value for money at all material times, when it comes to the provision of accommodation and the purchase of new  vehicles for official work.

All those public officials who engage in such profligate spending must be shown the door. Swiftly.

The case of the present Commissioner for Human Rights and Administrative Justice, Ms. Lauretta Vivian Lamptey, which has just come to light, following others in more or less the same vein that have also been recently unearthed, is most unfortunate.

If it is true, as some parliamentarians allege, that her capriciousness in demanding that her exact choice of sundry items be used in the refurbishment of her official residence - a project that has been ongoing for some three years apparently because of her fastidiousness - to ensure it is done to her taste, then in this particular instance she has not shown good judgement.

She failed to show the moderation required of senior public officials at a time of austerity: when so many of the ordinary Ghanaians whose taxes she apparently wants to be used to keep her in the style to which she has become accustomed, are themselves experiencing hard times.

The Commissioner for Human Rights and Administrative Justice is an important office holder whose position requires behaviour that is of a different standard from the norm  - an exemplary individual so principled in every aspect of his or her behaviour and character that all can safely look up to the Commissioner, secure in the knowledge that he or she is an individual of high moral standing, who posses sterling qualities and is always just and fair.

In other words, a veritable paragon of virtue, in whose hands one's human rights will always be safeguarded.

 Alas, on this occassion, Ms. Lauretta Vivian Lamptey has let herself down terribly. It would be better all round if she stepped down now. She must resign - as she is so clearly unsuited to the sensitive position she  currently occupies: which requires endless tact and infinite wisdom, all of which have sadly been  absent, in this unfortunate  matter.

It seems to have completely escaped her that these are exceptionally hard times in which millions of ordinary people are actually suffering - and struggle to survive on a daily basis. It was their taxes she was  frittering away with such abandon. Like all officials caught behaving in such unacceptable fashion, she must go. We must hold all public officials accountable when it comes to spending  taxpayers'  money. Her position is untenable. She should resign. A word to the wise...

Tuesday, 16 September 2014

Substantial Help At Last For Ebola-Stricken Liberia, Guinea & Sierra Leone

My heart went out to the people of Liberia, when I saw television news reports of President Ellen Johnson Sirleaf listening attentively to Ghana's President John Dramani Mahama, who had called on her a few days ago, when he undertook a trip to Ebola-stricken Liberia, Guinea and Sierra Leone, to confer with their leaders.

Liberia's leader looked so forlorn. Sadly, the Ebola fever virus outbreak has all but destroyed the economy of Liberia - which President Johnson Sirleaf  and her people have worked so hard to rebuild, after years of dictatorship preceeded by civil war.

The same can be said of Guinea and Sierra Leone - Liberia's immediate neighbours - both of which have also been badly hit by the Ebola fever virus outbreak. It all seems so unfair and cruel. Fate has not been kind to those sister nations of ours, at all.

However, at long last, help is on the way that could make a real difference  for the three nations in coping with the disaster that has befallen their people: President Barack Obama's administration is stepping in to help.

The U.S. is said to be preparing to send up to some 3,000 military personnel to Liberia - to help fight the west African Ebola fever outbreak. The Washington Post says the effort will cost about US$750 millions over 6 months.

Liberia is the hardest-hit of the three neighbouring states with the largest numbers of deaths from Ebola fever.

During what has been designated 'Operation United Assistance' U.S. military engineers will build 17 treatment centres,  each with a 100-bed capacity,  across Liberia. A 25-bed hospital to treat infected healthcare workers is also being prepared to be sent to Liberia.

65 United States Public Health Commissioned Officers will be deployed to manage and staff that hospital. 400,000 basic Ebola fever response kits will be supplied to households in Liberia. It will include sanitisers.

 The United States Agency for International Development (USAID) is also bringing in 50,000 home health-care kits from Denmark, which specially trained young volunteers will distribute to people living in remote rural  communities in Liberia, according to the same Washington Post news report by Lena Hunt.

 The U.S. military and specialists from the Centres for Disease Control and Prevention (CDC) will also help train up to 500 healthcare professionals a week in West Africa - in the care and treatment of those infected with the Ebola fever virus. The CDC already has as many as 100 specialists in west Africa currently.

Now that the U.S. military is stepping  in to work with international organisations on the ground in west Africa, such as:  Doctors Without Borders, other international  NGO's like Samaritan's Purse and healthcare professionals in the overwhelmed healthcare systems of the three hardest-hit nations experiencing the Ebola fever outbreak, one's hope is that the frightening projections of as many as over some 250,000 people eventually becoming infected with the Ebola fever virus across west Africa (including Ghana), will not now materialise.

 We must be thankful that at long last, the world's best-equipped military force is stepping in to help contain and halt the spread of the Ebola fever virus in Liberia, Guinea and Sierra Leone - as well as help train as many as 500 healthcare professionals a week, from across the region, in the treatment and care of Ebola fever patients.

That really is good news - for which we must all thank the government and people of the U.S.A.

And one is also certain that the leaders  and citizens of Liberia, Guinea and Sierra Leone,  will also be grateful that whiles others shunned them, Ghana's President Mahama came to visit them: to show his solidarity in the face of a common danger that threatens all of west Africa, as well as to donate food items to  Ebola fever patients in the three sister nations.

Thank goodness that substantial help is now finally coming to Ebola-stricken Liberia, Guinea and Sierra Leone: as the world wakes up to the dangers of a virus that has the potential to wipe out many if it is not contained within the next six months.

Saturday, 13 September 2014

How Ghana's 2014 FIFA World Cup Presidential Commission Can Outflank The GFA

There is no question that many football fans in Ghana are glad that President Mahama  set up a presidential commission to look into Ghana's participation in the 2014 FIFA World Cup tournament in Brazil.

 Those of us who initially advocated that that be done,  immediately after the debacle in Brazil, are certainly glad that the powers that be did so - and what shocking revelations there have been, thus far, at the public sittings of that commission.

For many taxpayers in Ghana, it is intolerable that whiles it has been happy to accept money from the national treasury over the years, the Ghana Football Association (GFA), has been quick to hide behind so-called "rules of FIFA"  (to use the French acronym for the French version of the organisation's English name, International Federation of Football Associations), to stop outsiders from conducting any investigations into its affairs.

Yet, there is a need to ensure that the GFA does not use its control of football in Ghana to misuse hapless Ghanaian taxpayers' money doled out to it by the government. Who, for example, will pay for that mercenary Serbian coach's salary, one wonders - taxpayers or the sly and opaque GFA?

(The shabby and disgraceful treatment meted out to the just-dismissed Black Stars coach, Kwesi Appiah, is rock-solid evidence of the GFA's perfidy, incidentally. Hopefully,  Kwesi Appiah will sue them in the law courts for breach of contract. Dismissing him for "bad faith" when he was only speaking the truth about a blatant lie the GFA wanted kept secret - that Kwesi Appiah had agreed to accept a technical director when he had not - is against natural justice and an abuse of his human right to speak out boldly: when confronted with an unacceptable and immoral conspiracy to foist a lie on the general public. In that instance, it was the GFA conspirators that showed bad faith, not Kwesi Appiah. He would be wise to appear before the commission to give them an insider's view of the shennanigens in the GFA, to help clean up the administration of soccer in Ghana. But I digress.)

 It is therefore vital that members of the presidential commission enquiring into the events surrounding Ghana's senior men's national soccer team's participation in the 2014 FIFA World Cup in Brazil, and the actions and inactions of those who organised it, ensure, when writing their final report, that based on their recommendations, in future no individual or groups of individuals can misuse taxpayers' money, in organising Ghana's participation in such international soccer tournaments.

To do so, they must set out in detail, precisely what kind of relationship  the government ought to have with the GFA - to guide all future allocations of taxpayers' money for Ghana's various national soccer teams to participate in tournaments organised by FIFA and its affiliate, the Confederation of African Football (CAF).

 Since the GFA is clearly unwilling to allow outsiders to investigate its finances, if they can get away with it, the presidential commission would be wise to talk to the English Football Association (FA) - between which, and Sep Blatter's FIFA, there is  little love lost, incidentally.

The English FA will happily provide the presidential commission's members with all the information they require about its financial relationship, if any, with the UK government. Who pays England's coach's salary,  for example? Ditto airline tickets for England's players and technical team when playing FIFA World Cup qualfyinfg matches abroad - the FA or the UK government?

And it will also give them a breakdown of  all the funds they receive regularly from FIFA, for the development of the game in England. Ditto its (group-stage) share of the profits that FIFA distributed as prize money, out of the US$567 million it set aside for that purpose, to all the participating teams in the 2014 FIFA World Cup tournament in  Brazil. (What, for example, is their opinion about a national team's "management committee" members allocating "appearance fees" given to the players participating in  a FIFA World Cup tournament to themselves too? They would be horrified to hear that that was the case for Ghana's senior men's national soccer team in the Brazil 2014 FIFA World Cup tournament, no doubt. But again, I digress.)

By talking to the English FA, the presidential commission looking into the events surrounding Ghana's participation in the 2014 FIFA World Cup tournament in Brazil, will be able to protect the interest of taxpayers when writing their final report,  and ensure that Ghanaian government officials and the GFA, do not misuse funds allocated by the government for Ghana's participation in international football tournament matches, going forward.

In other words, the presidential commission investigating events surrounding Ghana's participation in  the 2014 FIFA World Cup tournament in Brazil, can outflank the GFA, by talking directly to the English FA about the exact nature of its financial relationship with the UK government.

It can also discover from the English FA, what funds FIFA allocates to national football associations, if any, and for what purposes those funds are for - by asking them all the questions they would have wanted to ask the GFA but feel unable to, because it hides behind so-called FIFA "rules and regulations".

Ghanaians are fed up to the backteeth with the fact that no one in this country seems able to investigate allegations of corrupt practices in the GFA. Enough is enough. The presidential commission ought to talk to the English FA as soon as practicable. The GFA must be outflanked to discover the truth about its finances - and to find out whether or not it is taking Ghanaian taxpayers for a gigantic ride.  A word to the wise...

Monday, 8 September 2014

U.S. Ebola Doctor Reveals How American Healthcare Professionals Infected In West Africa Were Cured

Today, I am sharing an  article written by Dina Fine Maron - and posted in the August 27, 2014 online edition of the  Scientific American magazine  - which I have culled for the benefit of readers. 
One's hope in doing so, is that someone from the Ministry of Health and the Ghana Health Service will spot the article, and bring it to the attention of those in charge of Ghana's  response to the threat posed by the Ebola hemorrhagic fever virus (including all the professional associations of Ghana's healthcare workers).
If the techniques outlined below, which were used in the treatment of the American healthcare professionals who were flown back home to the U.S., after contracting Ebola fever in Liberia are  adopted by healthcare professionals in Ghana, it will doubtless help many survive the dreaded Ebola fever, should they be so unfortunate as to contract it here.

Incidentally, in total, four  U.S. healthcare professionals have contracted Ebola hemorrhagic fever in west Africa thus far,  and been flown home for treatment in the U.S. Please read on:
''This article is from the In-Depth Report Ebola: What You Need to Know

Ebola Doctor Reveals How Infected Americans Were Curedh,

Techniques used in the U.S. to treat symptoms and subdue the virus in patients could work overseas, Bruce Ribner says

Photo courtesy of PhotoDisc/GettyImage
Last week two American aid workers who had contracted Ebola while working in west Africa were released from a U.S. hospital and pronounced “recovered.” They had been flown to Emory University Hospital in Atlanta from Liberia earlier this month to receive care in the hospital’s specialized infectious disease unit. Kent Brantly, a physician with the humanitarian group Samaritan’s Purse, and missionary Nancy Writebol, of SIM USA, beat the strain of the disease they had contracted, which kills 52 percent of its victims. Bruce Ribner, medical director of the hospital's Infectious Disease Unit, sat down with Scientific American to explain how the two Americans were cared for, the lessons that could be applied to help patients across Africa and why the hysteria over flying the two individuals back to the U.S. was unfounded.

[An edited transcript of the interview follows.]

Are Brantly and Writebol now immune to the Zaire strain of Ebola?
In general, patients who have recovered from Ebola virus infection do develop a very robust immunity to the virus. They develop antibodies against the virus and they also develop cell-mediated immunity—the lymphocytes important to form viral control of pathogens. In general, the finding is it’s basically like being immunized—it would be unusual to get infection with the same strain.

Will that immunity afford them protection against other strains of Ebola?
We are still evaluating that in our two patients. Cross-protection is not quite as robust. There are five strains of Ebola viruses. Even though that data is not great, the feeling is there is potential for being infected if you go to a different part of Africa and get exposed to a different strain.

You said “still evaluating.” Are you still caring for Brantly and Writebol?
We are going to be following those two patients as outpatients, and as part of our evaluation they have agreed to undergo additional testing so we can better understand immunity to Ebola virus. We are meeting with them periodically.

What sort of lessons has Emory learned from caring for these two people that would be transferrable to patients in west Africa?
We are not being critical of our colleagues in west Africa. They suffer from a terrible lack of infrastructure and the sort of testing that everyone in our society takes for granted, such as the ability to do a complete blood count—measuring your red blood cells, your white blood cells and your platelets—which is done as part of any standard checkup here. The facility in Liberia where our two patients were didn’t even have this simple thing, which everyone assumes is done as part of your annual physical.

What we found in general is that among our Ebola patients, because of the amount of fluid they lost through diarrhea and vomiting, they had a lot of electrolyte abnormalities. And so replacing that with standard fluids [used in hospital settings] without monitoring will not do a very good job of replacing things like sodium and potassium. In both of our patients we found those levels to be very low. One of the messages we will be sending back to our colleagues is even if you don’t have the equipment to measure these levels, do be aware this is occurring when patients are having a lot of body fluid loss.

Our two patients also gained an enormous amount of fluid in their tissues, what we call edema. In Ebola virus disease there is damage to the liver and the liver no longer makes sufficient amount of protein; the proteins in the blood are very low and there is an enormous amount of fluid leakage out into the tissues. So one of the takeaway messages is to pay closer attention to that and perhaps early on try to replace some of these proteins that patients’ livers lack.

Considering how limited resources are in some of these facilities, could health care workers really act on this information?
I think the world is becoming aware that issues like this are not going to go away. The developed countries of the world will have to do our part to assist our colleagues with less developed infrastructure to care for sick people. I think one of the messages that is going out from many sources is we really have to help countries such as the ones involved in this outbreak to develop their medical infrastructure. Hopefully in five years they will have this infrastructure.

You have said that you are helping to develop new Ebola care guidelines based on your experience. How will those be disseminated?
We have several articles that we have submitted to major medical journals, which are read overseas, where we will be pointing this out. We are working with several government agencies, including the U.S. State Department, to help them come up with lessons learned—guidelines which they will distribute in turn to other countries. It is our goal to help our colleagues overseas.

Alternatively, what lessons did you learn from those health care workers?
Mostly the clinical course of the patients—much like any physician sending a patient to a referral center. They admitted they knew they were kind of flying blind. They’d say, “this is what we observed but we had no way to test it.”

The World Health Organization maintains that patients can continue to be infectious via their sexual fluids for several months after recovery. What did you recommend to Brantly and Writebol?
There are data that go back several decades—over several outbreaks—that suggest when you have individuals that have recovered from Ebola virus infection they may still be shedding nuclear material [genetic material from the virus which could potentially help spread it] in semen in males and vaginal secretions in females and also, potentially in urine. People have done this by doing assays looking specifically at the nuclear material of the virus. There has been very little attempt to demonstrate if this is viable virus that these individuals are shedding. It’s important when looking at epidemiological investigations that no one has been able to show people shedding these nuclear materials as a source of infection after they are discharged.

Looking at Ebola survivors who were discharged and successfully resolved the infection, following up several months later and evaluating their family members, there has never been any evidence that family members became infected. A lot of the thinking now is this probably was not live and is not important in terms of control of infection. We did give both of our patients the standard recommendations, which are contained on the CDC [U.S. Centers for Disease Control] Web site—not having unprotected sex for three months.

How many doctors and nurses were on your team caring for these two Ebola patients?
Twenty-one nurses, five physicians and we had the support of hundreds. Just making sure all the disposables coming out of those rooms were sterilized before we put them on the federal highway system, for example—we had to certify to the contractor that takes our regulated medical waste that it didn’t have active Ebola virus inside it. We didn’t have the equipment to handle all of the waste but in two hours facilities brought in industrial autoclaves [which sterilize materials with extreme heat] to replace the system that we had. We would have been drowning in garbage without them.

It has been reported that Brantly received a blood transfusion from a recovered patient. What role might that have played and is it being tried in other contexts?
I wouldn’t be able to tell you what I read in his chart. The most accurate thing to say is we don’t have a clue [what role a blood transfusion could play]. It’s not part of our standard treatment in our country. We wouldn’t have any idea whether he benefited or it was detrimental.

Are current diagnostics to identify Ebola virus disease adequate for this outbreak?
Certainly in the United States they are adequate. The major way one would diagnose Ebola virus disease is through a process called PCR or polymerase chain reaction, where you take the patient’s blood, put it in a machine and it tells you in a few hours if the nuclear material from the Ebola virus is present. CDC is doing that for patients coming back from infected areas where virus is a potential. There are a number of labs, both local and courtesy of CDC, that are doing this testing in west Africa, and my sense is it’s not that difficult to get it done.

This past week WHO announced that one of its workers has been infected with Ebola virus disease and that person was given the option of being sent to a different country for treatment. A British nurse also contracted the virus and went home to the U.K. for care. What’s the value of getting treated elsewhere?
Given that there is no treatment for Ebola virus disease, the main intervention that will determine if someone lives or dies with this infection is supportive care: The ability to replace fluid and electrolytes if a patient is losing them. The ability to replace platelets if that count is low and a patient is starting to bleed. The ability to replace protein in the blood that may be deficient. A developed country has the capability because of our infrastructure to provide that level of support is at a much higher level than a hospital dealing with patients in west Africa.

Among the handful of patients that received the experimental drug ZMapp, some have died. Considering the mortality rate for the current Ebola strain is almost 50 percent what can we say about ZMapp?
Experimental drugs are experimental drugs because we don’t know if they will work. That is true both with the preparations patients received in Liberia and other preparations that are being considered for treating patients with this infectious disease. We are a long way from being able to say that someone that received one of these agents benefited, it had no impact or it may be that their outcome may be impeded. Until we have good studies looking at outcomes of patients who received these medications, compared to patients who didn’t receive them, we should be very cautious.

I would go further to say that there is a fair amount of almost hysteria and people feeling they must have these preparations to survive. In the past people thought they needed agents for treatment, and the agents actually turned out to impair people’s ability to survive. The focus should remain on aggressive intensive care and the ability to correct abnormalities metabolically, rather than receiving any magic vaccine or product that may or may not improve survival.

For example, there used to be a belief that patients who had bacterial sepsis did much better if you gave them high doses of steroids. Now we know that these may be detrimental instead of beneficial. We know now since we’ve done the studies. Again, it was one of those things where people felt like “yeah this should be” but when they did the study in randomized patients they found it didn’t work at all.

As you know, two upcoming clinical trials will be looking at potential Ebola vaccines, and there are also a variety of experimental therapies that are being discussed in the U.S. and elsewhere beyond ZMapp. How should such information be coordinated? Does there need to be an entity overseeing that?
Given that we have multiple countries I don’t know that you can have any one entity. It’s tricky enough having the FDA [U.S. Food and Drug Administration] monitor what is going on in the United States. Clearly if you are talking about Canadian studies or European products, I don’t know that there is any entity that can provide that sort of coordination. My guess is that most of the manufacturers are aware of what the others are doing and are comparing notes because they feel it’s to their benefit to work together.

An ethics panel from WHO recently said that it is ethical to give out experimental treatments to Ebola patients, but it has not yet specified who should have priority in such circumstances or how such drugs should be doled out. They are taking up that issue at a meeting next week. What’s your thought?
I think it’s certainly ethical to study experimental biologicals and vaccines but we have to be extremely cautious. It’s not as though we have something that we know works. To say that anyone is withholding products implies we know that there’s a benefit, which gives me pause because we are a long long way from demonstrating that these offer any benefit in humans.

Is there anything you would like to add about insights you learned from your Ebola patient care?
The major thing I hope people have appreciated is there was a lot of anxiety, a lot of negative comment about our bringing these two patients back to our facility to care for them. Most of that we attribute to poor education, and I’m hoping that since we were successful in helping them resolve their infections it helps to dispel the idea that this is a disease that by nature has to be fatal. As we have been saying all along, we feel that the high fatality rates in developing parts of the world where this infection occurs are because of the lack of resources. We had always felt that the survival of patients with proper support would be a lot better than in developing countries.

The other thing I would hope we would get across to the public is this is a disease where we don’t have to have a lot of secondary infections—if we follow standard infection-control procedures. We had 26 people giving direct patient care to these patients and we did not have any secondary infections at all, and that’s as we expected.

We were using contact precautions and droplet precautions. Fortunately, we don’t have to go to that level of protection [wearing protective full-body suits like in west Africa]. You wear whatever you need so that the blood and body secretions don’t come into contact with you, depending on the quantity of fluids. We used gowns and gloves and foot coverings of the health care workers in order to prevent contact with the body materials of these individuals. Our approach was what CDC recommends: you wear a mask and goggles or a face shield to prevent that infection. Some of the nurses spending three to four hours in patients’ rooms were more comfortable wearing hoods than masks and face shields, though those would have been adequate. We can manage care with minimal chance for secondary spread. It’s not as though we brought the plague to American shores.''

End of culled article written by  Dina Fine Maron   and posted in the August 27, 2014 online edition of the  Scientific American magazine.

Wednesday, 3 September 2014

Ghana's Leaders Must Stop Selling Their Nation Short

One often wonders, whether there are moments of quiet reflection, during which many patriotic Ghanaians ponder over what could possibly be the rationale for the many one-sided agreements, which some of their nation's leaders end up signing with foreign investors - even though those agreements are detrimental to Ghana's long-term interests.

Could it perhaps also be the case that those discerning and independent-minded Ghanaian patriots, find it baffling that on top of that outrage, there are many leading politicians (mostly highly-intelligent and well-educated individuals) prepared to publicly justify even the most reprehensible and unjustifiable of agreements, which Ghana signs with foreign multinational corporations?

The question then is: What motivates those highly-placed public officials and politicians, who let Ghana down so badly, by approving such detrimental agreements? Do they never think of the well-being of their nation and the welfare of its people?

If we had 60/40 percent production-sharing agreements in Ghana's favour, for example,  instead of being lumbered with the world's worst oil agreements with foreign oil companies, Ghana could literally self-finance: all planned modernisation and expansion projects to enhance its infrastructure; provide well-designed and well-built affordable housing in new green cities nationwide; provide  free education from kindergarten to tertiary level for all those with the aptitude to study; as well as give all its citizens free quality-healthcare in  world-class hospitals - meaning that ordinary Ghanaians would be able to enjoy the same high standards of living enjoyed by the citizens of Saudi Arabia and the wealthy Arabian Gulf states (all of which incidentally have production-sharing agreements with foreign oil companies, it must be noted).

 And yet another example of an odious, selling-Ghana-short-agreement that  is  detrimental to Ghana's long-term interests, is the Atuabo port agreement between Ghana and Lonrho - which was rubber-stamped by a Parliament constitutionally mandated to scrutinise and prevent Ghana from being lumbered with precisely such  patently unfair agreements.

 Predictably, and true to form, many leading members of the National Democratic Congress (NDC), are trying to  justify what is an egregious example of the socialisation of private risk.

 Clearly, Lonrho wants to take advantage of all the opportunities inherent in a market economy - but it also wants to eat its cake and have it in Ghana's case.

"They have no doubt had excellent coaching lessons from the foreign oil companies with whom they are planning to prosper mightily together at Mother Ghana's expense", to quote an old wag I know.

So, today, Lonrho wants the state in what is an African democracy, and a free society in which the rule of law prevails, to protect it from potential competitors - by granting it a virtual monopoly that flagrantly flouts our laws (Section 5 (1) of PNDC Law 160 of 1986, which established the Ghana Ports and Harbours Authority). How can that be?

Yet, only recently, the NDC's Mr. Amertepe Kwame,  claimed on Peace FM's Kokrokoo morning show programme that in seeking to prevent potential competitors from engaging in the same kinds of businesses sought by Lonrho,  in the Atuabo port agreement with Ghana, the NDC government was only seeking to protect the company's investment. Amazing.

Perhaps the question that the Amertepe Kwames in our midst ought to ponder over is: Would Lonrho have dared to demand the same outrageous terms and conditions from the authorities in either the UK or Germany (or elsewhere in the rest of the European Union (EU) for that matter), in a proposal for an agreement to invest in building a new port along their coastline? Definitely not, is the short answer.

 A long-standing policy of the authorities in all the EU member states (and the European Commission itself in its Brussels headquarters) has been to ensure  that competition is never compromised in all such instances.

That is why active steps have always been taken by the European Commission and the authorities in all the EU member-states to prevent companies from establishing monopolies when investing in their national economies. Why then should the situation be any different for Lonrho in Ghana?

Has competition in the telecoms sector, for example, in which foreign telecommunications companies have invested billions of dollars,  not benefitted the Ghanaian economy?

In addition to giving consumers affordable access to sundry wireless broadband internet services, and connecting millions of mobile phone users to each other across the country, have they not created employment opportunities for tens of thousands countrywide, despite the intense competition in the industry?

 For the information of the Amertepe Kwames, the only 'protection' that any government in the 4th Republic can lawfully offer any foreign investor - at any given point in time - is the constitutional guarantee that legitimate businesses of theirs will not be expropriated. Nothing more, nothing less.

 (And lest they forget, the something-for-nothing-ripp-off-culture that prevailed during the colonial era, which enabled unimaginable wealth acquired through scandalous profiteering to be shipped out of Africa, was supposed to have ended some 57 odd years ago in Ghana - when Osagyefo Dr. Kwame Nkrumah's Convention People's Party (CPP) government took over the running of the country from the British colonialists who once occupied it. But I digress.)

 With respect, do we not operate a  market economy in Ghana - and therefore, presumably rely on market forces, not the power of the state, to determine the eventual fate of companies investing in our national economy: be they domestic or foreign?