medical journal of therapeutics africa

MedicalJournal ofTherapeuticsAfricaVolume 3 Number 2 February 2009

KNOWLEDGE • COMMUNICATION • HEALTH

Nairobi at night. Wanjiru Akinyi Waruingi BSc(Hons), PhD

PUBLISHERSEmerald Pademelon Press LLC

EDITOR-IN-CHIEFWA Waruingi BSc(Hons), PhD

BUSINESS ADMINISTRATORD Adore

MANAGING EDITORSA Reinhart MS

EDITORIAL BOARDRD Bartucci DO

K Dabas BPharm, MBA, MSNB Datyner BE, PhD

A Ekundayo PhDKH Golebowski

A Guantai BPharm, PhDND Ifudu BPharm, PhD

HAB Increase-Coker BPharm, PhDA Inyang PhD

D Kulkarni PharmD, JDM Lwenya BPharm, RPh

TJ Lisinski PhD, MSL McFerran

A McIntosh BSc (Hons), PhDM Norton

OK Oyenuga BPharm, RPh, PhDAZ Dodgson Pekala MS

CD Pitts IV PharmDS Ray

MS Rudman MDG Sowunmi PharmD

S Sundaram PhDTW Teketel MDR Verret PhD

S Viswanathan BPharm, MSTM Zydowsky, Ph.D.

NATIONAL ACCOUNTS REPRESENTATIVEMedical Journal of Therapeutics Africa

GRAPHIC DESIGNWA Waruingi BSc(Hons), PhD

COMPOSITIONEmerald Pademelon Press, LLC

Medical Journal of Therapeutics Africa is a profes-sional medical journal. Its mission is to facilitatecommunication between the pharmaceutical indus-tries in the United States and the 53 countries ofAfrica to lengthen the lives of humans in Africa.

We select articles for publication on scientific merit,relevance to the issue focus, and contribution to theongoing dialog between pharmaceutical industry

professionals in the US and Africa. No articles areproduct endorsements or advertisements. All adver-tisements will be clearly marked as advertisements.

Authors’ opinions are their own and may not be theopinions of the Medical Journal of TherapeuticsAfrica, its editorial board, its publishing board, itseditors or its advertisers. Medical Journal ofTherapeutics Africa, its publishing board, editors,editorial board and advertisers assume no liability orresponsibility for claims, actions or damages result-ing from the publishing of any article.

AUTHOR INFORMATION. Authors retain copyrightfor their articles, so permission to print, copy orreprint individual articles or parts of an article mustbe obtained from the author. To submit articles,send to the Managing Editors at [email protected].

Medical Journal of Therapeutics Africa is published12 times a year by Emerald Pademelon Press, LLC,PO Box 381, Haddonfield, New Jersey 08033.

Edited and typeset in the USA. Medical Journal ofTherapeutics Africa is published as a pdf which isdisseminated by e-mail and is additionally accessedat http://mjota.org and other sites.

Contents of the Medical Journal of TherapeuticsAfrica are protected by the US Copyright Laws.Reproduction, photocopying, storage or transmis-sion by magnetic or electronic means is strictly pro-hibited by law. ISSN 1934-3507.

CLASSIFIED ADVERTISEMENTS AND SPONSOR-SHIPS: MJoTA, Ms Adore, PO Box 381, Haddonfield,New Jersey 08033, [email protected].

MJoTA VIDEO AND AUDIO STUDIOS: Contact MsAdore, [email protected].

MJoTA FINANCE TEAM: Contact Prof Waruingi,[email protected].

Medical Journal of Therapeutics AfricaVolume 3 Number 2 February 2009

KNOWLEDGE • COMMUNICATION • HEALTH


Instructions to authorsFor consideration by the Editors and the Editorialboard, all manuscripts must be written according tothe uniform requirements for manuscripts submittedto biomedical journals, which are posted onwww.icmje.org. We also adhere to the EditorialPolicy Statements prepared by the Council ofScience Editors (CSE) at http://www.councilscienceeditors.org/services/draft_approved.cfm.

Our style and editing guidelines can be obtainedfrom the Editor-in-Chief. In brief, add only 1 spacebetween sentences, number the references sequen-tially in the text and list the references in the samestyle as PubMed.

The preferred manner of submission is as an attach-ment on an e-mail, with pictures of figures andtables sent camera-ready as high resolution jpg files.Under special circumstances, manuscripts will beaccepted by posted mail or fax.

We accept letters, literature review articles and dataarticles giving original research, and magazine arti-cles telling stories. Articles should generally haveunder 3,000 words.

Original data articles need to be in the form Abstract(200 words maximum), Introduction, Methods,Results, Discussion.

Magazine articles are narratives and have no pro-scribed structure; accompanying photographs areencouraged. They may be as short as 200 words oras long as 10,000 words, however, they must befocused and tightly written.

We do not pay for medical journal articles or formagazine articles. You will retain the copyright foryour journal or magazine article when you assign tous rights to publish your article in an issue of MedicalJournal of Therapeutics Africa.

Each journal and magazine article is reviewed by atleast 2 members of the editorial board and the edi-tor-in-chief, and outside reviewers as the need aris-es. We adhere to the requirement of the NationalLibrary of Medicine for inclusion of journals in theirdatabase is that “neither the advertising content norcommercial sponsorship should raise questionsabout the objectivity of the published material.”

All articles published are required to meet the stan-

dards of the National Library of Medicine. Our majorcriteria for selecting each article are scientific merit,relevance to our target audience quality of writing,and relevance to the focus of the issue.

We invite submission of articles reporting any dataor information that will nurture the dialog betweenpharmaceutical industry professionals in Africa andthe United States. These articles will include clinicaland preclinical studies, reviews of current clinicaland preclinical studies, discussion of devices andmedications, case reports.

Submissions of review articles and case reports mustbe preceded by communication with the Editor-in-Chief. We also invite submission of letters to theEditor, which should address observations in clinicalpractice, early results of studies, discussion of appli-cations of basic research to clinical practice or dis-cussion of clinical guidelines.

We will only accept for submission for considerationby the Editorial Board articles sent as attachments toe-mail letters. Please first send an e-mail with acover letter, then send a second e-mail with the arti-cle attached. We will only lay out articles for publi-cation if the manuscript has been prepared inMicrosoft Word or equivalent word-processing pro-gram.

When we accept the article for review, we will e-mailyou a form which you need to sign, stating that youare the senior author of the article under review andthat all tables and figures are either original or youhave proof that you are permitted to reproducethem. We also need you to give us permission topublish the article in Medical Journal of TherapeuticsAfrica and permission for your article to be down-loaded in context with other articles.

Send articles to:EditorsE-mail: [email protected]


Table of ContentsCover 43Masthead 44Instructions to Authors 45Table of Contents 46

Daily UpdatesWaruingi Akinyi Waruingi BSc(Hons), PhD. January 2009. 47-57

Chronic diseaseAndrew Reinhart MS. Centers for Disease Control: diabetes. 58 Pharmaceutical manufacturers WA Waruingi BSc(Hons), PhD. Pharmaceutical manufacturing in Kenya. 59-61Zimbabwe UpdatesTewodros W Teketel MD. Cholera epidemic in Zimbabwe. 62-3Snakes Fernando Bergamaschi de Souza. The Brazilian Snakes Project. 64-5Pharmaceutical industry professionalsMJoTA Medical Writer Training. 66-8

Celebration of President Obama’s inauguration at Metropolitan Church AME in Thomas Circle,Washington DC. Masthead page: the Kenyan Ambassador to the United States.

01 Jan 2008

Happy New Year 2009!!!!

Already a great New Year: I have been receiving goodwishes all morning from my wonderful African friends inthe United States and throughout Africa! So much enthu-siasm for 2009 when the young, vital, brilliant, focusedPresident Obama will be leading the United States!

We are always thirsting for leaders, begging for someoneto tell us what to do, gather us together to take us to thePromised Land.

When I was a small girl in New Zealand I found in myparent's library a huge book, called "Our Island History"which was about the island the Romans called Britannia.I was enthralled by stories of the British warrior queenBoadicea, who went into battle with her children. They alldied repelling whoever it was.

Brave, and stupid. An example of a bad leader. A leaderorganizes safe care for children (surely she knew some-one who could hide them in a forest, run with them some-where?) A leader should lead, not expend his or her mostvaliuable talent: that of bringing people together.

My New Year's wishes to you all are to try to get 2009without doing anything destructive, or stupid. Do not leadinto a battle that will end in destruction. If you want tolead, do not lie about your achievements, about where youlive, about your relationships with your colleagues, aboutyour criminal record, about why you cannot get a greencard.

If you do not want to lead, do whatever you need to cre-ate a safe bubble around yourself. If you want to be led,are yearning for a silver-tongued leader, listen to speech-es by Ghandi, Churchill, Martin Luther King jr, WangariMaathi, Professor Dora. Listen to great leaders, authenticleaders, but do not follow false prophets who tell you thatall you have to do is buy shares in a diaspora companyand you will find the promised land in Naivasha.

I am not a leader. What interests me is data and honestyand bearing witness to professional successes in Africa.However, I find myself in daily contact with profession-als who have the ability to move large capital, and otherswho bear witness to misery, and who need large capitalfor their dreams to alleviate misery. MJoTA Finance Teamalready has professionals in Africa and the United States,and is looking for more fiscally literate finance profes-

sionals who are decent, honest and do not lie about wherethey live, what they do.

So what are the ground rules for working with MJoTA?Be who you say you are. To my core I believe in redemp-tion and forgiveness, as does everyone growing up inAustralia which was founded on the brilliance and hardwork of former convicts. When you start interacting withme, I do not ask questions, you have a clean slate, I expectyou to behave like an adult, do not lie to me, do not coercemoney from me with promises you have no intention ofkeeping.

Because when I catch you in a lie, I start looking to dis-cover if anything you have said was true. I want to findout what a reference means: "soulful visionary" and "whoknows how to make change happen". I need the referenceto list changes that have happened, other than to the rap-idly diminishing bank accounts of your supporters, and toyour children you do not ever contact.

But here is the bottom line: Happy New Year! Be happy,be brave, fight your own battles, love your children tolife, not death.

Page 47 Volume 3, Number 2 2009 Medical Journal of Therapeutics Africa

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http://[email protected]

Above: Atlantic City New Jersey boardwalk heli-copter, no longer functional, painted in zebrastrips. Photo courtesy Macharia Waruingi. Left:Haddonfield, New Jersey, Election Day 2008.

WA Waruingi BSc(Hons), PhD. Daily Updates. January. MJoTA 2009:3(2):47-57.

05 Jan 2009

Very sad news here in Philadelphia. In the earlyhours of New Year's Day Kambili Moukwa died in thecity. He was 22, the only son of a professional fam-ily living in North Carolina. His father is MosongoMoukwa PhD, who came from Congo to study in theUnited States and now works for a company basedin Mumbai, India that manufactures paint.

Bitterly tragic, the young Mr Moukwa worked in thePhiladelphia Mayor's office (maybe I have seen him),was a University of Pennsylvania senior, and was onhis way towards a stellar career. Mr Moukwa startedwalking through an empty parking lot, and nevermade it. MJoTA sends condolences, prayers to allwhose lives Mr Moukwa touched.

Everyone in the United States is back to work, backto school today. Medical Journal of TherapeuticsAfrica weekly webinars start today: you are invitedto join us if you are interested in writing, editing arti-cles, or know someone who is, or are just curious.

Send an email to [email protected] for accesscodes to the GoToMeeting web-site so you can log into see my computer screen and hear what everyoneis saying.

MJoTA Medical Writing training webinars starttomorrow, 10am to noon. The first webinar teachesskills and resources needed to start a career as amedical writer. MJoTA courses are for health and sci-ence professionals who already have advanceddegrees (MS, PhD, MD, DO, PharmD, DBA, DHA).

From MJoTA friend in Italy Aldo Ceccarelli:

"Two updates from ISF about free patient manage-ment software for hospitals:

We have currently volunteers operating in 2 missionsopen at Matiri (Kenya) and Angal (Uganda) whereOpen Hospital free software has just been released:http://www. informat ic i senzaf ront iere .org/viewnew.php?id=72. Software is available for down-load and free open source use for download fromhttp://sourceforge.net/projects/angal. Windows andLinux releases are available for use from USB pen-drive."


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Philadelphia in the morning and evening duringOdunde celebrations, June 2008. Above: near CityHall. Below, near African American Museum ofPhiladelphia. Right, In City Hall, before and afterMayor’s Africa-Philadelphia conference.

07 Jan 2009

I drove into Baltimore today to meet William BriegerPhD, who is on faculty at Johns Hopkins School ofMedicine. Bill lived and worked in Nigeria for someyears, where he was faculty at the University ofIbadan. He is an academic scientist of Europeanancestry who loves Nigeria and Nigerians as muchas I do.

Dr Brieger is described on his webpage as SeniorMalaria Specialist, JHPIEGO; Certified HealthEducation Specialist, and as Professor in the JohnsHopkins Blomberg School of Public Health.

Each morning Bill compiles stories about malariafrom press releases, published papers and sendsthese out each day to everyone who signs up to hise-mail list. You can read his malaria blog, moreabout him and his work fighting malaria on his web-page, screenshot on right.

Malaria was eliminated in the United States, Europeand Puerto Rico by spraying DDT from the late1940s through the 1960s. Once Europeans andAmericans had eliminated malaria we banned DDT.A total ban. No manufacture, no storage, no study-ing. Since 31 Dec 1972 in the United States.

Our first issue of Medical Journal of TherapeuticsAfrica in January 2007 focused on malaria, andevery issue since then has included something aboutmalaria. In 2008 we have published several articleson malaria, including More Malaria Drugs are need-ed by Lori McFerran (MJoTA 2008,2(3):240-3,http://www.mjota.org/images/mjota6malaria231-5lmf.pdf), Challenges in Eliminating Malaria byMelanie Palaisa (MJoTA 2008,2(3):227-8), andStructural Adjustment Program, Roll Back Malariaand Increasing Disease Mortality by MachariaWaruingi (MJoTA 2008,2(3):229-30).


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William Brieger in his office at Johns HopkinsUniversity, Baltimore below. Outside his office: theuniversity and hospital, right.

09 Jan 2009

Yesterday was the United States Institute of Peace(USIP) Passing the Baton conference. USIP wasformed by some lawmakers in 1984; it is a largegroup of researchers who assemble data that can beused to maintain peace. On their website, usip.org,their purpose is described as finding nonviolent solu-tions to resolving international conflicts.

The conference attracted nearly 50 speakers andmore than 1,900 participants, mostly fromWashington DC think tanks, universities, lobbygroups and media. We heard from Condaleeza Rice,Madeleine Albright, Zbigniew Brzezinski, GeneralPetraeus, Senator Richard Lugar, William Perry.

We also heard from the head of the World Bank,Robert Zoellick, who gave a talk at lunch. Mostalarming was hearing about nations arming withnuclear weapons.

Most encouraging was hearing about bloggers inKenya who tracked the violence and murders oneyear ago: great optimism from experts in cybersecurity in instant witness to local events; great pes-simism from the same experts that we all put far toomuch information on the internet.

I chatted with Jimmy Mulla, President of SouthernSudanese Voice for Freedom. He is an engineer, hiswebsite is shown lower right. He tells me SouthernSudan needs rebuilding. War, systematic rape, mur-der continues. The group has an office in

Washington DC. We hope to publish articles fromSudan from Jimmy, and from David Gallivan, ayoung Quaker lawyer whose 3-year assignment as alegal officer for peace groups in Sudan starts in May.


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Building in Washington DC, above; below andright, scenes from the USIP conference.

12 Jan 2009

On Friday 09 January I showed up at the NationalAcademy of Science in Washington CDC, before9am, to listen to a lecture by Dr Calestous Juma. DrJuma is a scientist, and is on faculty at HarvardKennedy School where his titles are Professor of thePractice of International Development and Director,Science Technology & Innovation, Belfer Center forScience and International Affairs.

Dr Juma talked to us for nearly 3 hours about hiswork in Africa and everywhere else. My goodness,so much energy, so many wonderful projects: I lovethe polymers that absorb rain before it evaporatesso plants can grow. He was introduced by a seniorscientist and government official from Japan. DrJuma works with brilliant scientists everywhere,which is what brilliant scientists do.

Both scientists were introduced by a senior scientistat the National Academy of Science who said that hedid not know how to introduce Dr Juma, because heknew no-one who doesn't know him. Which is whywe have MJoTA. Circles everywhere in the UnitedStates, in Africa, in universities: professionals onlytalking to each other, only knowing each other. Quiteunaware of what is there at the end of their earth.

What blew us away was his presentation on the 100dollar laptops. What really blew me away was thepicture of the Pope with a 100 dollar laptop. Gosh.

These laptops are made of indestructible plastic andlook like toys that my children had that needed to belost, they were never going to wear out. They weredesigned by brilliant Massachusetts Institute ofTechnology types who wanted laptops for childrenwho are 6 to 12, and who are, well, kids. Whichmeans they drop things, throw things, spill things:and the laptop had to be able to absorb kid-abuse,and work, and keep children up-to-date and online.

The laptop batteries last 4 hours, but they areincreasing this to 7 hours, to 40 hours. Dr Juma toldus that battery charging can be creative: with gen-erators being cows walking around, bicycles, solarpanels, anything that transferred energy.

I watched with delight as genius scientists - we werein the National Academy of Science - tried to openthe laptops. The laptops had been demonstrated by2 young girls (see right) who opened them, firedthem up, twirled them around, got them online andactive. When the girls left, they closed the laptopsand handed them to adults. Who could not figure fortheir lives how to open them. You have to think likea child, who has small fingers and not any strength.Finally after pressing buttons and pulling on anten-

nae I saw one being opened, by yanking the 2halves apart. Which is what a child would do!


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15 Jan 2009

Today is the anniversary of the birth of a great man,a great orator, a great leader, Martin Luther King jnr.

It is also the anniversary of the birth of MJoTA. For2 years, through adversary, misunderstandings, uni-versity officials going from telling me that MJoTAwas the most original thing coming out of the uni-versity to telling me I was suspended for "hiringAfrican professionals and relatives", sons of Africatelling me that their ventures would organize andgalvanize professionals to cure malaria. All I had todo was invest my life savings in them, first in BAVstudios in Maryland and Nollywood, and second, incompanies called KDNC and Ustawi in Missouri andNew Jersey and Nairobi.

Well, both endeavors were great fun, and got mephysically into West Africa and East Africa, but mygoodness, anyone wanting to invest money or timein businesses, make sure they sign a contract torepay you, and give you a business plan that youagree with. And check 5 people they have workedwith previously to make sure that are really goinginto this in good faith, and not just playing gamesbecause, hey, it is not their money!

Through the infinite grace of God, MJoTA is thrivingand today I heard from an academic physician inEthiopia! And today we publish articles on Zimbabwefrom an African professional, another Ethiopianphysician, and a relative, Gillian Hakli, my cousinfrom Finland.

Starting publication on 15 January 2007 was not aco-incidence. I wanted to honor this day becauseMJoTA started because decent European Americanslistened and watched and decided that havingfriends and colleagues of African ancestry was notenough unless we actively worked with our AfricanAmerican brothers and sisters to overturn social sys-tems that institutionalized the absurdity that anyoneof African ancestry belonged to a subclass. Thehearts of European Americans needed to understandthe sufferings of their brothers and sisters. Dr Kingpreached a passive revolution, as had Ghandi, butrevolution nonetheless. And gradually, 40 years afterDr King's death, European Americans are listening,and voted in a President who is a child of Africa. Butmore listening is needed. And MJoTA is trying itshardest to listen, to bear witness, to overturn socialsystems in science and medicine.

Publication of MJoTA vol 3 number 1 is startingtoday. From now for the next week, articles will bepublished, and on Monday 26 January the wholeissue will be downloadable as an integrated pdf.

Two years of continuous publication! So many won-derful writers, scientists, health professionals, pho-tographers, editors, and relatives to thank.

First, University of the Sciences in Philadelphia, aninstitution I loved very much. They gave me theopportunity to start a medical journal to bear wit-ness to excellence in Africa. Two years later theymoved my program to a Dean whose highest aca-demic qualification was Master of Arts. He had nounderstanding of academic research, and no interestin MJoTA. He terminated my appointment.

From August 2006 to April 2008, Osagie Edoro-Ighalo stayed in my house frequently, and I stayedin his house and his family took care of me in Nigeria(Grace Edoro! You seriously rock!) , he gave MJoTAcontent help, connections to West African profes-sionals and manuscript review.

From March 2008 to November 2008 MachariaWaruingi lived in my house as part of my family,gave MJoTA content help, traveled with me fre-quently from Boston to New York City to WashingtonDC, connected me with East, West and SouthAfrican professionals, and reviewed manuscripts.

From August 2008 Professor Afe Ekundayo has sentmanuscripts, given advice, stayed with me inOsagie's sister's house in Lagos (Agatha Edoro, yourmanufacturing and management abilities need to beused all through Nigeria) and in my house in NewJersey. She is now Deputy Provost of Ambrose AlliUniversity in Edo State!

The University of Lagos Faculty of Pharmacy hassupported MJoTA from the beginning, sending arti-cles, being the subject of articles, taking me intotheir homes. The Dean of Pharmacy took me intiohis house for 2 weeks, and his wife fed me andtucked me into mosquito nets every night.


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18 Jan 2009

I have been publishing Medical Journal ofTherapeutics Africa now since 15 Jan 2007. Aftercoming up with the concept on a train ride fromBoston to Philadelphia on 22 May 2006 after aNational Writers Union training conference on con-tract negotiation, and a long phone conversationwith a Ghanaian engineer in Scotland who wanted togo back to Ghana but was trapped.

My goal for MJoTA from the first instant was to helpAfrican professionals return home so they can ownfactories, own hospitals, own hotels, and createwealth in their own communities, wealth that staysin their communities. We still have that goal, and wecelebrate health and science professionals who trainin the United States to work in their own communi-ties across Africa.

Personally, I have confused emotions when I inter-act with Africans living and working in the UnitedStates and Britain. I see many who have failed intheir professions in their African country, often nottheir fault, but once they arrive in the United Statesthey believe they are experts in international financeand healthcare and set up 1-person organizationsthat look huge and have web-sites, and they allcharge USD120 for membership. Membership ofwhat? And organize endless conferences that areonly attended by African immigrants (which are agood thing socially, but do not help fight poverty inAfrica) and set up companies that achieve nothingand are soon abandoned.

Confused emotions, because I have also seen suc-cessful professionals leave their countries to trainand have succeeded spectacularly in building hospi-tals and schools in their own countries: I have 3 con-crete examples in sub-Saharan Africa: 1 in EastAfrica, in Kenya, 2 in West Africa: in Nigeria and inGhana. These will be the subjects of articles in thecoming months.

The most successful model I have seen for Westernintervention stopping children die of preventable dis-eases is one or 2 wonderful caring humans adoptinga village in East Africa (and the 5 examples I haveare in East Africa) and building schools.

MJoTA has recently adopted as a recurring subjectone of these organizations, the Maasai HeritagePreservation Foundation. Matt Norton is a youngbusinessman in England who was driving with hiswife through Kenya when the car broke down. Theywere soon joined by a small boy. Matt's wife dugaround for a gift, and all she could find was 3 pen-cils. She gave them to the small boy, and that wasthe moment of transformation for Matt. He said hehad never before seen anyone so grateful, and hewanted to find out why. Turned out school wasrestricted to children with pencils, and the small boynow had his ticket to the future. Matt went back toEngland and hooked up with an American married toa Kenyan, and now they have built 3 schools in EastAfrica. Three schools!!! Matt will be reporting on hisschools on the MJoTA Daily Updates. I met himthrough Linkedin; he sent out an invitation for all tojoin by webinar a Maasai Christmas. Which wasdelightful, delightful.


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21 Jan 2009

Celebrating Africa, celebrating Kenya, celebratingAmerica, celebrating President Obama.

On Sunday, 19 January, I drove to Washington toworship at the AME church near Dupont Circle. Iparked my car near the Convention Center andwalked through the streets to the church, happilytaking the photographs on these pages. The servicewas an official event posted on the Kenyan Embassywebpage, and an envoy from the KenyanGovernment was there. The service itself was great:uplifting, arousing, celebratory. Speeches weregiven by the Kenyan Ambassador and the KenyanMinister for Foreign Affairs. Great speeches by greatpeacemakers: Ambassador His Excellency Peter NROOgego (far Minister the Hon Mr Wetang’ula (middleright, and next page), who led the Kenyan delega-tion. He is the Minister for Foreign Affairs, a lawyerwho was educated in a Quaker school.

The pictures on this page, and the next, were takenat the church service. I took my camera with me tothe inauguration activities on 20 January, but mycamera jammed and I did not have my son MilesPekala with me. Of course, he fixed it in 2 minutes

when he visited home a week later, shaking his headin disbelief that I could not fix it. Nor could 2 verycompetent Tanzanian gentlemen I approached inthe Kenyan Embassy party, and asked if they wereelectrical engineers. They were! So what was need-ed was Miles’ graduate degree in robotics.

Was far too cold, real-ly cold, and too busynetworking withKenyans, Tanzanians,G h a n a i a n s ,B o t s w a n i a n s ,Nigerians andAmericans to postanything yesterday! Iarose at 3am to driveto a metro stationoutside DC. Whichwas when the funbegan! Everyone wasexcited, delighted,thrilled beyond belief!I rode into DC with acheerful group fromFlorida. The leader of


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the group, clearly the leader, let me take pictures ofthem, and then took a picture that included me. Westopped at a station and he was teasing a man withFBI written on his clothes and guns strapped not justto his waist but to his leg. I was laughing, I told himI could not believe he was torturing the FBI! He wasthere with his children: his daughter told me hername was Kenya! He told me he was ex-marine: of

course. Who else wouldtake on the FBI?

We started to get an ideaof how many we werewhen we passed byMassachusetts Avemetro stop, and saw busafter bus after busparked.

Then a man sat next tome who told me he wasa teacher in Georgia, hehad flown from Atlantafor the Inauguration. Hetold me he travels fre-quently to Nigeria andKenya, and his groupwas building 2 hospitalsin Nigeria.

We moved in a hugemass out of the subwayonto Constitution Avenueand I started walking for-ward towards theCapitol. I managed toget as far as theSmithsonian Castle,which is right next to theMuseum of African Art. Idon't do well in crowds(a legacy of missing by 5


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The Kenyan Minister forForeign Affairs, the Hon MrMoses Guatangula

Below, Thomas Circle, near where the KenyanEmbassy reception was held on Inauguration Day.

minutes being blown up with 80 others in Bologna inAugust 1980), so I backed out through the masses.Hearing snippets of conversations: a huge Californiadelegation around Barbara Boxer, individuals flew infrom London. Many, many Africans, and many manydescendants of Africa living in the South.

I walked around and through crowds, enjoying theexcitement, feeling the might of the AmericanEmpire in the sky and the hundreds and hundreds ofcheerful police, army, marines, navy, airforce, andred capped volunteers. Everyone was taking photo-graphs: the crowds, the crowd controllers, the honorguards, and I heard, the Senators and theRepresentatives.

I ended up in an empty corner on PennsylvaniaAvenue, sitting on bleachers directly looking down15th Street. Empty, plenty of room to dance andwave arms around when Aretha sang, oh Lord! DidAretha sing!

I got colder and colder. For about an hour I was hud-dled under a blanket next to 2 sisters from Florida:one had driven with her husband 14 hours fromOrlando. And was getting ready to drive back afterthe parade. All around me my African, African-American, European-American brothers and sistershad gone to Herculean lengths to get to sit in thecold, cold winter sun to cheer on our 44th President.

Finally I just was too cold, and as the parade start-ed I headed towards the metro to find the KenyanEmbassy party. The metro did not warm me, everypart of me was shaking, even my head. I manageda cheerful conversation with a delighted young ladywho was waving flags and so, so pleased a brotherwas President. I shivered my way up the elevator toDupont Circle and bought coffee. That worked: Icould feel my blood warm and my life stop ebbing.

But, my goodness, the cold and the walk and theexhaustion: these were all worth it. I spoke to a poet

with both my name and my daughter's, a leader withthe name of a Biblical leader, a mediator with thename that Jesus loved, and an engineer. So muchhope with the dancers in the party, so much excite-ment, so much exuberance. We saw this month apeaceful transfer of power in Ghana, the first mod-ern country led by an indigenous African parliament;we witnessed the peaceful transition of power to ason of Africa in the United States. All the dancing, allthe exuberance are willing the same for Kenya dur-ing the next elections. And we saw the men andwomen dancing who will be part of the process.

After the party at the Kenyan Embassy was theKenyan Ball organized by Pastor Daniel Karanja PhD(he is the middle person in the left picture on p54,he is standing behind Dr Juma on p51). Joyful, excit-ing, inclusive. I always wear Nigerian clothes to suchevents, and needed my blouse zipped. In the ladiesroom I ran into 3 Nigerian ladies who not onlyzipped me, but also fixed my head piece and chat-ted about Nigeria and Kenya. My zipper was wearingKenyan flag earrings: we all acknowledged that thenight belonged to Kenya, but that President Obamabelongs to all of Africa and the United States.

The ball was oversubscribed, far more peopleshowed up than were tables available. But everyonestayed, at least until midnight when I turned to myescort, MJoTA Financial Team leader (he works qui-etly and effectively with our team which linksinvestors with those wanting to build hospitals, uni-versities), and told him that I had been up 21 hoursand maybe my driving ability would be impaired withlack of sleep and extreme cold all in one day.

But what a day. My first inauguration as a citizen in30 years. In fact, my first observation of transfer ofpower in any country where I was a citizen since Iwas 5. (I did run for Parliament in Australia beforecoming to the United States as a post-doc; no-oneever asked to see my passport. That was then.) Socold and so warm. God bless us all.


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23 Jan 2009

I have been enjoying reading articles in an onlinejournal published in Kenya, in Nairobi, the AfricanJournal of Food, Agriculture, Nutrition andDevelopment, http://www.ajfand.net/Vol8No3.html.Great articles on the relationship between agricul-ture and disease, which is in line with our interestsat MJoTA. They are well organized and have beenpublishing certainly since 2001 (from what I can seeon their web-site) and all articles published since atleast 2005 can be downloaded free.

We have a calendar page on the MJoTA web-site: wewant to hear about events that are of important tohealth of Africans. We want to write about lectures,celebrate success. We will certainly post any eventsimportant to Kenyans that we find onhttp://www.kdnc.org, and I really do adore Kenya,but Africa is 53 countries: we want to report onevents from all African countries. Tell us,[email protected].

26 Jan 2009

Happy Australia Day! Which is vestigial. When who-ever it was stuck a flag in the ground in Sydney andsaid that meant that everyone now had to buy allthe land and air and sea from him. Or the King ofEngland. Or some such nonsense.

Australia has had days of major apologies to theAustralian indigenes, the Aborigines. Long after theEnglish had killed most of them. Sigh. TheAustralians really are trying, have been in the grip ofredemption for a decade or so. Gave back land toAborigines. Really trying.

I read 2 interesting articles. The first, fromhttp://www.eastandard.net expressed concerns thata country with so many poor citizens would spend somuch money to send members of the Kenyan gov-ernment to the inauguration of President Obama.The second, from http://www.antrimtimes.co.ukreported that a recording studio prepared a record-ing contract for the Boys' Choir while the boys andtheir managers were waiting in London airport fortheir plane back to Nairobi.

30 Jan 2009

Everything posted about the situation in Zimbabwehas been moved to its own page:http://mjota.org/Zimbabwe.html.

We are always hearing about the rest of Africa inMJoTA. We have made contact with a young medicalstudent Mido at the University of Cairo, and his goodfriend, Ibrahim, who is studying computer systems.

The medical student Mido has already sent somelovely pictures, and given us a long list of prominentEgyptian physicians.

MJoTA vaguely remembers that medicine was animportant part of Ancient Egypt. Certainly writingcame out of there. The writer was considered in ranknext to the Pharaoh, because the writer could per-form magic: chiselling on stone ideas that are soephemeral that would remain in the stone long afterthe writer had died. Words have power. Writtenwords can transcend time. Wow!

31 Jan 2009

Around about now, the last day in January, the win-ter really seems to have dragged itself out longenough and we politely would like to ask it to leave.We have had enough cold, enough damp, enoughsnow. Thanks all the same.

Of course, in New Jersey, winter is rather timid, youwant a real winter you need to be in theSchwarzwald, which in English we call the BlackForest of Germany. I remember a conversationabout 15 years with an ancient lady restaurateurwho told us that during the second world warRussian prisoners captured by the German armywere brought to the village, and they complainedthat it was colder than on the Russian Front. Whichis the yardstick for cold.

I remember snow falling on our village in October,and a final snow thunderstorm dumping several feetof snow on Easter. My 2 Polish-American and 2German-American children loved it, and so did myGerman husband who took off by starlight for longnight ski-trips. But me, who lived in New Zealandand Australia and whose atavistic yearnings havealways been for sub-Saharan Africa, I just got cold-er and colder, and wrote stories about sunshine andoranges and distant stars.

By the Publisher and Editor-in-Chief


DAILY UPDATES


Princeton University, New Jersey, 23 Jan 2009.

Centers for Disease Control: Diabetes Diabetes is a serious disease affecting humans inAfrica and in the United States. It can lead to blind-ness, nerve damage, kidney disease, leg amputa-tions, heart disease, and stroke, thus diabetes man-agement is a serious health concern. According tothe Centers for Disease Control (CDC,http://www.cdc.gov/diabetes), in 2004, 3.2 millionAfrican-Americans had diabetes, which is more than13% of all African-Americans of 20 or older.Diabetes was the fourth-leading cause of death inAfrican-Americans in 2004. Additionally, the numberof African-Americans diagnosed with diabetesincreased between 1988 and 2004.The National Diabetes Education Program (NDEP)developed a curriculum to assist African-Americancommunities increase awareness for the need forappropriate diet and physical activity. Power toPrevent: A Family Lifestyle Approach to DiabetesPrevention bases its approach on principles estab-lished by the Diabetes Prevention Program of 2002,which showed that Type 2 diabetes can be prevent-ed or delayed in those at risk through weight loss,diet, and exercise. The NDEP recommends physicalactivity 5 days a week, and a reduced-fat low-calo-rie diet, and gives 50 tips on how to do it. The NDEP,a program run by the National Institutes of Health(http://www.ndep.nih.gov/diabetes/), is linked tothe Centers for Disease Control website.African-Americans are 1.8 to 2 times as likely tohave diabetes as are non-Hispanic whites.Additionally, African-Americans are more likely toexperience complications of diabetes than are non-Hispanic whites: 50% more likely to experience dia-betic retinopathy, 3 to 6 times as likely to experiencekidney disease, and almost 3 times as likely to haveleg amputations.Other programs are linked to the Centers for DiseaseControl website to assist in educating minority pop-ulations in delaying or preventing diabetes. AfricanAmerican Initiatives, a program developed by theAmerican Diabetes Association, is accessed throughthe Centers for Disease Control website. AfricanAmerican Initiatives is designed to increase aware-ness of diabetes in members of and professionalsworking in African-American communities, provideinformation about the seriousness of diabetes andits complications, teach the importance of makinghealthy lifestyle choices, and educate those with orat risk for diabetes about prevention, treatment, andmanagement of the disease.The Office of Minority Health Research Coordination,a service of the National Institute of Diabetes andDigestive Kidney Diseases, has also been created toaddress the burden of diseases and disorders,

including diabetes, thatdisproportionately impactthe health of minority pop-ulations. The Office ofMinority Health ResearchCoordination funds trainingfor researchers from tradi-tionally underserved com-munities, including African-American communities,and places greater emphasis on research into areasof health disparity.By Andrew Reinhart MSMr Reinhart trained in chemistry and biochemistry atUniv North Carolina (Chapel Hill), Washington Univ(St Louis), and Univ Missouri-Columbia. He hasworked for over 5 years in preclinical and nonclinicalresearch. He is an expert in regulatory documenta-tion, particularly FDA nonclinical and preclinical doc-umentation. His resume is on http://mjota.org, andon Linkedin. He is the MJoTA Nonclinical ManagingEditor. E-mail: [email protected].


CHRONIC DISEASE


Reinhart A. Centers for Disease Control: Diabetes. MJoTA 2009, 3(2):58.

Impaired fasting glucose is a condition inwhich the fasting blood sugar level is 100 to125mg/dL after an overnight fast. Prevalence of impaired fasting glucose in peopleaged 20 years or older, United States, 2007• In 2003–2006, 25.9% of United States adults 20years or older had it (35.4% of adults 60 years orolder). Applying this percentage to the entire U.S.population suggests that at least 57 millionAmerican adults had prediabetes in 2007.• After adjusting for population age and sex dif-ferences, prevalence among United States adultsaged 20 years or older in 2003–2006 was 21.1%for non-Hispanic blacks, 25.1% for non-Hispanicwhites, and 26.1% for Mexican Americans.From National Diabetes Fact Sheet 2007, athttp://apps.nccd.cdc.gov/ddtstrs/FactSheet.aspx

Online newspaper Business Daily Africa below, reportsthe burden of diabetes in children in Nairobi.

Pharmaceutical manufacturing inKenyaMEMBERS OF THE KENYAN ASSOCIATION OFMANUFACTURERS

According to the web-site of the Kenya Associationof Manufacturers, they have 615 member compa-nies, of which 455 are in Nairobi and surroundingareas, and 23 in Nakuru.

The association reports 20 member companiesdescribed as Pharmaceutical and Medical EquipmentManufacturers, these are listed on the right column.

Of the 20 companies listed, 5 had web-sites thatwere accessible from the KAM web-site. A briefdescription of each company follows.

Alpha Medical Manufacturers Limited manufac-turers syringes. It has an installed capacity of 72million syringes (1, 2, 5, 10, and 20mL) with readystocks of over 8 million disposable syringes with dis-posable needles. According to their website(http://www.amml.net) they additionally trade andstock medial surgical supplies, bandages, gloves,fluids, IV cannulas and IV sets.Dawa Limited manufactures analgesics, antialler-gics and respiratory agents, antibiotics, penicillinderivatives, antimalarials and artemisin combinationtherapies, central nervous system-acting drugs, gas-trointestinals, nutritional supplements, surgicals andveterinary products plus antihelminthic agents, cor-ticosteroids, skin agents and hormones. Theiraddress is Baba Dogo Road, Kenya. On theirCompany Information page on their web-site(http://www.dawalimited.com) they state “DawaLimited ...(is) manufacturing the whole range ofquality pharmaceutical products for both human and

livestock purposes (to) exacting WHO GMP stan-dards. Dawa Limited is an established QZA/GMPcompliant manufacturing facility that is both efficientand has a high production capacity.”Glaxo Smithkline Kenya Limited web-pageclicks to the international website athttp://www.gsk.com. An article on the GSK web-site


PHARMACEUTICAL MANUFACTURERS


Table 1. Member companies of KenyaAssociation of Manufacturers described asPharmaceutical and Medical EquipmentManufacturers. Factories are mostly in ornear Nairobi. 1. African Cotton Industries Limited2. Alpha Medical Manufacturers Limited3. Beta Healthcare International Limited4. Biodeal Laboratories Limited5. Bulk Medicals Limited6. Cosmos Limited7. Dawa Limited8. Elys Chemicals Industries Limited9. Gesto Pharmaceuticals Limited 10. GlaxoSmithKline Kenya Limited 11. KAM Pharmacy Limited 12. Laboratory & Allied Limited 13. Manhar Brothers (K) Limited 14. Medivet Products Limited 15. Novelty Manufacturing Limited16. Pharm Access Africa Limited 17. Pharmaceutical Manufacturing Co (K) Limited 18. Regal Pharmaceuticals 19. Revital Healthcare (EPZ) K 20. Universal Corporation Limited

WA Waruingi BSc(Hons), PhD. Pharmaceutical manufacturers. Pharmaceutical manufacturing in Kenya. MJoTA 2009:3(2):59-61.

was written by Elana Stolpner MD(MJoTA2008,2(3)).Laboratory & Allied Limited was “incorporated inNovember 1970 as a private trading company deal-ing mainly in general healthcare sundries, toiletries,laboratory chemicals and glassware, and other relat-ed products” according to their web-site athttp://wwww.laballied.com. And, they “took calcu-lated advantage of the government policy of sup-porting local entrepreneurs in the pharmaceuticalsector, to increase manufacturing capacity and capa-bility, by investing heavily in pharmaceutical manu-facturing. L&A grew to become one of the leadingsuppliers of quality-approved pharmaceutical prod-ucts to the government's Essential DrugsProgramme.” Their range of drugs includes anal-gesics and antipyretics, antacids, antiulcer agents,antiamoebics, aerobicidals, antiasthmatics, antibi-otics, antifungals, antihelminthics, antihistaminesand antiallergics, antihypertensives, antimalarials,antirhematics and antiinflamatories, chemothera-peutics, cough expectorants and antitussives, der-matological preparations, eye, ear, nose and throatpreparations, local vaginal reactants, over-the-counter products, tranquilizers, vitamins andhematopoetics and verterinary products. Pharm Access Africa Limited does not appearfrom their web-site to manufacture drugs, theyappear to link donor and investment agencies withneed. Their web-site is http://www.pharmacces-safrica.com.Companies that have websites which are not acces-sible from the KAM web-site are listed below. African Cotton Industries Limited (http://www.africacotton.com) was started in 1954, and now hasover 450 employees in Nairobi. They make cottonwool, toilet paper, feminine towels, serviettes (nap-kins), facial tissues, pocket tissues, kitchen towels,petroleum jelly, hair conditioner, surgical gauze infactoreis in Mobasa and Nairobi. They have sometestimonials for the toilet paper on their web-site,they are clearly very proud of their success in man-ufacturing and selling toilet paper.Beta Healthcare International Limited did nothave its own web-site. From various web-sites, thiscompany appears to be a subsidiary of an Indiancompany, which appears to make and distributepharmaceutical products in Kenya. The current Headat Beta Healthcare International Limited Kenya wastrained in management in Mubai, India.Biodeal Laboratories Limited is an Indian com-pany that manufactures drugs in India and distrib-utes them in Kenya. No evidence was found formanufacturing in Kenya. Senior management in thecompany in India are listed on the web-site,

http://www.biodealindia.com, as 3 medical gradu-ates with postgraduate qualifications. Bulk Medicals Limited has a post office box andphone and fax numbers listed next to their geo-graphic address, which is Nairobi Kenya. In the web-site http://www.pharmacyboardkenya.org, this com-pany is listed as having manufactured a registereddrug, 100mg carbocisteine on 16 June 2005. Theyare listed in the Nairobi phonebook as being manu-facturers, agents and distributors.Cosmos Limited has drugs registered by theMinistry of Health Pharmacy and Poisons Board:these drugs include antimalarials, antibiotics andanalgesics and antiretrovirals, see box at lower right.




Alpha Medical ManufacturersAventis Pasteur SA East AfricaBayer East Africa LimitedBeta Healthcare (Shelys Pharmaceuticals)Cosmos LimitedDawa Pharmaceuticals LimitedDidy PharmaceuticalDiversey LeverEli Lilly (Suisse) SAElys Chemical Industries LimitedGlaxoSmithKlineHigh Chem East Africa LimitedIvee Aqua EPZ Limited Athi RiverMac’s Pharmaceutical LimitedManhar Brothers (Kenya) LimitedNovartis Rhone Poulenic LimitedNovelty Manufacturers LimitedPfizer Corp (Agency)Pharmaceutical Manufacturing Co (K) LimitedPharmaceutical Products LimitedPhillips Pharmaceuticals LimitedRegal Pharmaceutical LimitedUniversal Pharmaceutical LimitedTable 2. List of manufacturing companies inKenya, from Kenya’s Pharmaceutical Industry2005. All have faqctories in Nairobi except IveeAqua EPZ Limited, which is in Athi River.

GlaxoSmithKline ... agreed to a voluntary licensewith the Kenyan-based generic pharmaceuticalmanufacturer Cosmos to produce generic forms ofthe antiretroviral drugs zidovudine and lamivu-dine.... Cosmos will be able to sell the drugs inKenya, Burundi, Rwanda, Tanzania and Uganda..23 Sep 2004, http://www.theglobalfund.org

Universal Corporation limited is based in India.It manufacturers drugs near to Nairobi, according toits web-site (http://ucl.co.ke), a total of 42, whichinclude antimalarials, analgesics, antibiotics, antifun-gals and antiretrovirals.Revital Healthcare (EPZ) K makes surgicalinstruments in Mombasa, web-site is http://revital-healthcare.com.Regal Pharmaceuticals is a wholly Kenyan ownedpharmaceutical company http://regal.regalpharma-ceuticals.com that manufacturing analgesics,antacids & antispasmodics, anthelminthics, antibi-otics, antihistamines, antimalarials, corticosteroids,cough preparations, cold remedies, multivitamins &tonics, topicals.Elys Chemicals Industries Limited does nothave a web-page. The Pharmacy and Poisons Boardlists it as a manufacturer, and as having registereddrugs including vitamins, pain relievers, antibioticsand cold medicines.KENYA’S PHARMACEUTICAL INDUSTRY 2005Kenya’s Pharmaceutical Industry 2005, prepared bythe Export Processing Zones Authority, was down-loaded from http://www.epzakenya.com. It listswhat it calls “some of the leading pharmaceuticalmanufacturing companies in Kenya”, they are givenin Table 2. From the list from the Kenya ManufacturingAssociation site, and the list from the ExportProcessing company, the conclusion MJoTA makes isthat of these pharmaceutical companies, only DawaPharmaceuticals Limited and Regal Pharmaceuticalsare wholly owned and operated by Kenyans, and inboth companies, the Kenyans are of Indian ancestry.The only other company that is wholly Kenyan-owned is the African Cotton Company.The second conclusion is that several companies

manufacture drugs elsewhere, mostly in India, andhave ethical drugs registered with the KenyanPoisons and Control Board which they distributethroughout Kenya and East Africa. These companiesare registered in the Nairobi telephone book, aremembers of the Kenya Manufacturers Associationand are certainly complying with national and inter-national laws. However, they do not meet the MJoTAdefinition of a Kenyan pharmaceutical manufacturermaking drugs in Kenya.Several of the companies listed in the Nairobi phonebook are in Kenya less to distribute drugs which aremade elsewhere, but more to run clinical trials inKenya, although they are employers in the UnitedStates, where MJoTA is produced. These companiesinclude Aventis Pasteur (which is now Sanofi-Aventis), Bayer, Eli Lilly, GlaxoSmithKline, NovartisRhone Poulenc, Pfizer. Clinical trials of pharmaceuti-cal products ongoing in Kenya are given in Table 3.By Wanjiru Akinyi Waruingi BSc(Hons), PhD




Table 3. From the United States Health andHuman Services Clinical Trials Database atClinicalTrials.gov:In Feb 2009, 38,248 clinical trials were reported inthe US, 81 clinical trials were reported in Kenya.In Kenya:-32 studies tested therapies for preventing andtreating malaria-33 studies tested therapies for preventing andtreating HIV/AIDS-2 studies were for treating tuberculosis-21 studies were funded by industry-7 studies tested the efficacy of vaccines-0 studies of cardiovascular disease, hypertension,diabetes, cancer

Businesses in Nakuru, in the Rift Valley of Kenya. Photos by the Editor-in-Chief.

Cholera Epidemic in Zimbabwe28 JANUARY 2009. INFORMATION FROM MSFPHYSICIANS IN ZIMBABWE.

"MSF (all sections combined) has seen more than12,000 patients since August in Zimbabwe's worstcholera outbreak in years and has opened dozens ofcholera treatment centres throughout the country.Cases have been found in nearly all provinces. Over500 national and international MSF staff membersare working to identify new cases and to treatpatients in need of care. The highest number ofhumans with illness had been seen since the start ofNovember. The emergency was declared officiallyonly on the 4th of December, and the governmentasked the international help.

MSF-OCA has 2 cholera treatment centres in Harareand in some areas north and north-east of Harare.The highest number of people treated so far wasduring the last week in November in the capital townwhen the teams saw more than 2,000 humans with300 to 350 new patients per day. More then 7,000humans were treated up to the first week ofDecember.

MSF-OCBA, in Beitbridge (in the south, near the bor-der with South Africa), has set up cholera treatmentcentres and they are covering also in the north ofthe region. The team there has treated over 3,000humans.

MSF-OCB has conducted assessment missions intorural communities where a few humans have beensickened with cholera, and established small choleratreatment units. MSF-OCB has 8 cholera treatmentunits in 5 districts in the Manicaland and Mashvingoprovinces in the eastern part of Zimbabwe. We have15 expats on the ground and saw 770 humans withcholera in the first 3 weeks in our rural structures.

In addition, we want to be prepared in case of esca-lating violence in Harare, and be able to provide careto victims. We have identified a structure where wecan set up services and we are organizing a team torun the activities. Internal Operational Newsletter [email protected]." Edited from MSFnewsletter

29 JANUARY 2009. FUNDS NEEDED TO SEND MED-ICAL SUPPLIES FOR ZIMABABWE.

I am trying to send medical supplies to a hospital inZimbabwe I used to work with. The hospital didn't

have medical supplies for more than 5 years. theyhave been getting small donations from missionarieswho first started it. MSF (Doctors Without Borders)is also supporting in many ways. The organizationwho promised me to donate the supplies is calledMedwish international. They collect all unused but tobe disposed medical materials from all over the US.... the hospital doesn't have any funds.

02 MARCH 2009. UPDATES ON CHOLERA INZIMABABWE FROM DR TEKETEL

Here is the latest news on the cholera epidemic fromMSF. The epidemic is not slowing.


ZIMBABWE


"WASHINGTON DC, 28 Jan 2009. The UnitedStates Agency for International Development(USAID) continues to provide assistance to thepeople of Zimbabwe in the aftermath of a wide-spread cholera outbreak that began in August2008. USAID is consigning nearly 440,000 bars ofsoap-valued at nearly USD365,000-to the UnitedNations Children's Fund, which will provide it tohumanitarian organizations to distribute as part ofhygiene education programs in areas most affect-ed by the cholera outbreak.According to WHO, the cholera outbreak inZimbabwe has now affected all provinces and 57out of 62 districts. As of January 22, 2009, morethan 48,000 cases of cholera and 2,755 deathshave been reported.Cholera is usually transmitted through contami-nated water or food. Outbreaks can occur sporad-ically in any part of the world where water supply,sanitation, food safety, and hygiene are inade-quate and spread rapidly in areas with inadequatetreatment of sewage and drinking water. Althoughcholera is contagious, it can be prevented. USAIDand the international community are diligentlyworking in Zimbabwe to help prevent the spreadof the disease.To date, USAID has pledged USD6.8 million inemergency assistance for Zimbabwe's cholera out-break. USAID's assistance is supporting the provi-sion of emergency relief supplies for affected pop-ulations, humanitarian coordination and informa-tion management, and water, sanitation, andhygiene (WASH) and health interventions.This assistance is in addition to the more thanUSD4million that USAID has provided for emer-gency WASH programs in Zimbabwe since October2007. The United States Government has providedmore than USD264 million in humanitarian assis-tance for Zimbabwe's ongoing health and food cri-sis since October 2007."

Doctors Without Borders (http://www.msf.org) has acomprehensive website, where the good works they doare explained. On their site is a donations page .

“The historic cholera outbreak continues throughoutZimbabwe. As noted previously, the focus of the out-break has shifted from the cities to the rural areas,but the cities are still a concern. In general, the epi-demic seems to be following a trend from northeastto southwest of the country. MSF has treated nearly45,000 patients since the outbreak began in August.

In the rural areas of Masvingo and Manicalandprovinces, teams are still seeing a significant num-ber of humans with cholera – for example, duringweek 5, the teams saw more than 1,300. MSF teamsare focusing on the ongoing cholera epidemic butare also keeping an eye on other health issues suchas malaria – the malaria has season started - andnutrition.” Edited from MSF newsletter

MSF released a paper on the humanitarian crisis inZimbabwe beyond the cholera epidemic on 17February, http://www.msf.org/source/countries/africa/zimbabwe/2009/Zimbabwe_Beyond_Cholera_Feb09.pdf. There was a press conference inJohannesburg with the MSF International President,Dr Christophe Fournier, OCBA Head of MissionManuel Lopez, and South Africa Head of MissionRachel Cohen.

By Tewodros W Teketel MDDr Teketel is on the MJoTA Editorial Board, and heco-ordinates the news from Zimbabwe. Dr Teketalis an Ethiopian physician who has worked in publichealth for over a decade in Africa, Europe and theUnited States. He worked in 2007 in Zimbabwe as aphysician with Doctors Without Borders (MSF).

30 JANUARY 2009. PLEAS FOR HELP FORZIMBABWE FROM SOUTH AFRICA

The situation in Zimbabwe has now reached the tip-ping point. Essential services including health, sani-tation and education have collapsed completely.There is mass starvation in the country as most peo-ple are surviving on one meal or less a day. Deathsdue to the cholera and the HIV/ AIDS epidemic arerising rapidly, exacerbated by shortages of cleanwater, food and medicines.

Additionally, the suppression of democratic free-doms through abductions, torture and other sinisterforms of intimidation continues unabated, indicatingtotal breakdown of the rule of law. At this criticaljuncture, SADC and African governments must actresolutely to protect the people of Zimbabwe whoare being subjected to a passive genocide. The suf-fering of the people of Zimbabwe cannot be ignoredany longer. Sign our petition, http://savezimbab-wenow.com/ and add your voice to this call for

action which will be sent to President KgalemaMotlanthe in his capacity as Chairperson, SouthernAfrican Development Community (SADC)."

by Sandra dos Santos-PiresMs Santos-Pires is a marketing strategist in SouthAfrica, [email protected]


ZIMBABWE


WASHINGTON DC, 11 Feb 2009. The collapse ofthe health system has left the people of Zimbabweat great risk of contracting illnesses such ascholera, which claimed more than 3,400 lives, andincreased the threat of a malaria epidemic.To help mitigate a malaria outbreak, the UnitedStates Agency for International Development(USAID) is supporting emergency indoor residualspraying to fill gaps in the country's traditionallystrong malaria control program.Timing is critical; in most years spraying should becompleted by December. But Zimbabwe's nationalmalaria program lacks the financial resources toachieve three quarters of its scheduled spraying,which would target 20 high-risk districts and pro-tect more than 400,000 households.To respond to the critical gap and avoid anothercatastrophic epidemic caused by the near collapseof Zimbabwe's health sector, USAID providedUSD200,000 in emergency funding, matched withGBP200,000 from the UK's Department forInternational Development. This accelerated pro-gram will apply the insecticide in February andMarch before the usual peak in cases in April andMay. The US and UK organizations coordinatedthe program with WHO and implementing part-ners John Snow International, Crown Agents, andPLAN International, which organized the opera-tion's logistics, personnel, equipment, and man-agement needs.Indoor residual spraying applies a WHO-approvedinsecticide to the indoor walls, ceilings, and eavesof houses to kill or shorten the lifetime of mosqui-toes that carry the malaria parasite. Decades ofexperience have shown that timely and properlyconducted spraying can have an immediate anddramatic impact on malaria transmission.Combined with the increased deployment of long-lasting insecticide-treated bednets, diagnostics,and drugs, indoor residual spraying will play amajor role in reducing the risk of a malaria epi-demic in Zimbabwe-and yet another burden in analready severe humanitarian crisis.Press release from USAID. Malaria pro-grams at USAID are reported onhttp://www.usaid.gov/and onhttp://www.pmi.gov/.

The Brazilian Snakes ProjectIn 2005 in Brazil, the Ministry of Health reported100,000 contacts of humans with venomous ani-mals. According to the Ministry of Health, each yearencounters with humans include 20,000 by snakes,5,000 by spiders and 8,000 by scorpions, causingdeath, temporary or permanent incapacitation.

According to the Brazlilian Ministry of Health, snakesbite approximately 20,000 humans each year.According to the World Health Organization, global-ly, each year 4.5 million humans are bitten bysnakes. As many as 50 to 75% of those bittenrequire treatment to prevent death, amputations orpermanent sequel.

In countries inhabited by venomous insects and rep-tiles, the animals do not leave when towns and citiesdevelop if there is a constant food source for thesnakes. Consequently, humans living in areas wherevenomous creatures proliferate are frequently indanger of injury or death. Snakes and spiders hap-pily take residence inside houses in the middle ofBrazilian cities: finding poisonous spiders in beds atnight is not unusual.

The Brazilian Snakes Project is a multi-media com-munications project aimed at identifying the snakesof Brazil. The Project maintains an internet site,

http://www.brazilian-snakes.com, and plans to pub-lish a printed field manual, a printed children’s bookand a DVD, in both Portuguese and English.

The main goal of the Brazilian Snakes Project is toprepare a database so that the right treatment canbe quickly made available when a human is injuredby vipers, snakes, spiders, centipedes, scorpions,caterpillars. The database will also enable differenti-ation between non-venomous animals and ven-omous animals before humans are injured.

The main reasons for embarking on the Project arefirst, to protect and treat victims injured by ven-omous animals, and second, to protect the ecologyof Brazil. Snakes have an important ecological func-tion in controling the population of rodents, rats andinsects and hence make a large contribution to pre-venting illnesses and epidemics. Brazil needs itssnakes, but Brazil also needs its humans to be safeand co-exist with snakes and other venomous ani-mals. Understanding the snakes, understanding


SNAKES


What To DO if You or Someone Else is Bittenby a Snake1. If you or someone you know are bitten, try tosee and remember the color and shape of thesnake, which can help with treatment of the snakebite.2. Keep the bitten person still and calm. This canslow down the spread of venom if the snake ispoisonous.3. Seek medical attention as soon as possible.4. Call local emergency Medical Services.5. Apply first aid if you cannot get the person tothe hospital right away.a. Lay or sit the person down with the bite below

the level of the heart.b. Tell him or her to stay calm and still.c. Cover the bite with a clean, dry dressing.

What NOT To Do if You or Someone Else isBitten by a Snake1. Do not pick up the snake or try to trap it (thismay put you or someone else at risk for a bite).2. Do not apply a tourniquet.3. Do not slash the wound with a knife.4. Do not suck out the venom.5. Do not apply ice or immerse the wound inwater.6. Do not drink alcohol as a pain killer.7. Do not drink caffeinated beverages.From the United States Centers for DiseaseControl, http://www.cdc.gov

Fernando Bergamaschi de Souza. Snakes. The Brazilian Snakes Project. MJoTA 2009:3(2):64-5.

what to do when humans are injured, having theavailability of anti-venom in hospitals within travel-ling distance of injured humans: these are all goalsof the Snake Project which can only be achieved byeducation and amassing a database on the snakes.

Brazil is known to have 326 species of snakes, ofthese are 56 are venomous. The Project has anambitious scope: to photograph in controlled set-tings each known venomous snake in Brazil, as wellas approximately 100 non-venomous snakes. Eachanimal will have his descriptive page with necessaryinformation for supply subsidies in vital and immedi-ate decision-making, as well additional facts abouthabitat, habits, ways of preservation and care.

The organizers have amassed a large number of let-ters in support of it from hospitals and other institu-tions throughout Brazil, http://www.brazilian-snakes.com/recomendation-letters.html. So far,these hospitals number 27, and each hospital repre-sents a large population center.

By Fernando Bergamaschi de SouzaMr Bergamaschi is a freelance photographer livingand working in Brazil, web-site, http://www.photoin-dustrial.com. Telephone, 55-21-40627499; e-mail,[email protected]. Mr Bergamaschi tookall these pictures in snake-infested country in Brazil.


SNAKES


The Snake Project needs funds to continue

Seeking work as a medical writerWHAT IS A MEDICAL WRITER?

A medical writer is a scientist who understands therules of data, can find data and translate clinical,nonclinical, and preclinical data into documents thatmay be manuscripts, slideshows, posters, regulato-ry documents. A medical writer needs a strong back-ground in life sciences, otherwise the manuscriptswritten can look beautiful, and make no sense.

DO YOU WANT TO BE A MEDICAL WRITER?

Are you sure you can be a medical writer? The firstrequirement is that the market has to exist: in theAmericas, Europe, and Asia the market existsbecause these continents house thriving pharma-ceutical industries. The second requirement is a firmyes to each of the following questions: Do you loveto write? Do you love the English language? Dowords, phrases, grammatical constructs excite you?Do you read everything you can about health andscience? Do you read every article in the New YorkTimes health section? When you were growing up,did you agonize between a career in the humanitiesor life sciences? When you discovered the existenceof the career of medical writing, did you feel for thefirst time that the universe understood you?

DO YOU HAVE MEDICAL WRITING SKILLS?

All these questions need a yes. Are your English lan-guage skills superior? Are your research skills supe-rior? Are your editing skills superior? Do you under-stand biochemistry, physiology, microbiology, anato-my, pharmacology? When you are given a therapeu-tics area: can you find out everything about the dis-ease, therapies, clinical trials, drug manufactures ofdrugs for the disease within a day? Do you knowwhich documents are required by the Food and DrugAdministration? Can you prepare these documents?Can you prepare a slideshow from a clinical studyreport? Can you prepare a slideshow on a disease?With notes? Or edit one?

WHAT STORY DOES YOUR RESUME TELL?

Does your resume give confidence that you are ver-satile, willing to learn anything, rapidly able to cometo speed on any therapy topic, that you know docu-mentation and presentation, that you can conductyourself in a meeting, and prepare reports from themeeting? Do you have anything in your resume thatmakes you unique? Does your resume show that youare a team player, that you volunteer, that you careabout life and the world, and that you care about theplacing of a space, a comma? The employer reading

your resume is walking through the marketplacewith money to find the right medical writer.

WHAT IS YOUR MARKET?

Do you know who would hire you based on theresume you have prepared? How many jobs doesthat open yourself to?

HOW DO YOU MARKET YOURSELF?

Do you have a website? When your name isgoogled, what is found? Lines of articles you havewritten, community service, statements on onlinegroups? Are you visible in the marketplace?

WHERE DO YOU MARKET YOURSELF?

Do you know any medical writers? Are you a mem-ber of American Medical Writers Association,amwa.org? Do you have your capabilities listed in itsfreelance market? Do you have details about yourskills on Monster, on Linkedin, anywhere else?

HOW WILL WRITING AND EDITING ARTICLES FORMJOTA HELP GET JOBS AS A MEDICAL WRITER?

MJoTA is the first and only themed publication pre-pared by medical writers, and all articles are peer-reviewed. If you write the article, you are the author.When you write for MJoTA, you write on an aspecton health and wealth creation that builds your cred-ibility as an expert. You can showcase your skills inresearch, writing, editing and demonstrate that youare an expert in a particular field. If you want to bean expert on FDA documentation, we encourage youto write articles on FDA regulations and documenta-tion. Writing articles for MJoTA shows that you careabout humans outside your own condition, becauseyou are writing about humans living, working anddying in the 53 countries of Africa.

HOW DO YOU COMMUNICATE WITH CLIENTS?

Do you spend a day, or a week, preparing for aphone interview? Do you find out everything you canabout the company and the job? During your prepa-ration, do you realize that you are lacking skills? Doyou really want the job? In the interview, do you lis-ten to the client tell you what the job requires? Doyou tell them what you want? Do you explain yourskill set? Do you invite the potential client or employ-er to a webinar where you present what you can doby Powerpoint? I heard a story about an actress whowanted a job so badly she told the employers thatshe certainly was an expert roller skater, and skatingbackwards and to music would be no problem. Shewas hired, and on the way home from the interviewenrolled in rollerskating lessons.


MEDICAL WRITING


Medical Writing Training MJoTA works with life sciences professionals, whohave graduate degrees, towards a regulatory writingcareer or a marketing writing career. Core training isneeded in both: you cannot write manuscripts,abstracts, posters and powerpoint presentations ifyou do not understand clinical trial documentation.The training is not complex, but does involve a largetime commitment from the professional. The goal oftraining is simple: show you can write documentsthat are believed by your peers.

WEEKLY WEBINARS

We give medical writing training.

1. Choosing topics for articles, editing articles forupcoming issues, MJoTA Editorial Meeting, Mondays

2. Medical writing marketing & editing, Tuesdays

3. Clinical trials data & health statistics, Mondays

4. Regulatory documentation, Thursdays

5. MJoTA Talks. Thursdays. Open to all.

MJOTA MENTORSHIP PROGRAM

At MJoTA we work with professionals in theAmericas, Europe, Asia and Africa with strong sci-ence backgrounds, and with advanced degrees inlife sciences (MS, MD, PhD, RPh, PharmD, DHA,DBA). We also accept trained journalists.

We require students in the mentorship pro-gram to write at least 3 articles for MedicalJournal of Therapeutics Africa over 3 months.

You have a choice in the mentorship program:

RW1: Writing documents for regulatory authorities.If you are local to Washington, or can visit, we inviteyou to come with us to open FDA sessions.

MW1:Medical writing for continuing medical educa-tion, medical journals,magazines, sales represen-tatives, poster presenta-tions, monographs.

HOW WE TRAIN MEDICALWRITERS

We are online, but studentsare always welcome to stopby. We teach by phone, bye-mail, by discussion boardon Linked-In, by Skype,and by GoToMeeting.


MEDICAL WRITER


Minimum requirements for award of aMJoTA Medical Writing Certificate

1. Prepare resumes, post them on online

2. Prepare a portfolio which includes:a.CME-style PowerPoint presentationb.Peer-reviewed articles published in

MJoTA (at least 3)c.Presentations and documents

demonstrating competency in FDA documentation preparation and rules

3. Pass a 3-hour exam on clinical statistics anddata

4. Pass a 3-hour exam on clinical study reportwriting competency

5. Prepare a poster from a clinical trial articlepublished in NEJM

6. Prepare an article from data from databases.

Fees until August 2009

We charge USD110 to participate in an individualwebinar, or USD1,000 for unlimited webinars for-ever with mentorship and help getting jobs.

The global economy. MJoTA has watched withits mouth open the Dow Jones Index going up anddown from day to day since the end of September,and is cheering on the stimulus package. What weknow is colleagues in the pharmaceutical industryare being laid off: clinical trials specialists, regula-tory affairs specialists, statisticians, programmers,medical writers, lawyers, recruiters. We believethat the pharmaceutical industry is tightening itsbelt for the long haul, and that it will be hiringagain as soon as it can get credit to run clinical tri-als and continue with research and development.When this happens, MJoTA wants all our people tobe ready with glistening resumes, portfolios andshining faces.

“During the 4 years I was the Director of the med-ical writing program at USP, I designed andtaught many courses, and was involved in cur-riculum development for all courses. One thingwas clear: highly educated professionals do notneed another degree, what they need is direction,and the “killer ap” of medical writing training iswork as a medical writer.”

Susanna J Dodgson BSc(Hons), PhD, Publisher and Editor-in-Chief, Medical Journal of Therapeutics Africa

How MJoTA MentorsA. WEBINARS

1. Once weekly editorial webinars Mondays 7-9pm.2. Weekly webinars for regulatory documentation,data and statistics, medical writing skills for men-torees.3. Weekly MJoTA Talks (Thursdays 4-5pm, repeated9-10pm) is open to the public, and is an opportuni-ty to showcase articles and MJoTA staff. MJoTA writ-ers are encouraged to present their work, or talks onany topic that relates to MJoTA.4. Articles will be worked on until publishable.5. Resumes, cover letters will be assessed, changed.6. We stay with you until you have a job, and arethere for you when you look for your next job. Weare a co-operative, everyone is expected to worktogether.7. We will work with you on your portfolio, on MJoTAarticles, slideshows, posters, abstracts, websites andanything you have contracted externally to write.These are your credentials; writers must be able toresearch, handle data, write a great story and edit.Your portfolio shows that you can do these things.8. We will tell you about conferences, webinars,events where you can attend for information or net-working.9. We will work with you to focus on what you needto succeed. We can help you succeed if you work onyour portfolio, on your networking, and work toaddress gaps in your understanding.10. We assign writing, we will work on the assign-ments with you. Occasionally we may pay you forwork on external contracts MJoTA wins.11. We assign reading. Writers read. Nonstop.Everything. Every article in MJoTA.12. We let you write for MJoTA on topics that inter-est you, but if you do not have any topics, or youneed them assigned, we will assign them.

What is Required of a MentoreeA. APPLYING FOR JOBS

1. Know why you want to work as a medical writer,and why preparing articles for MJoTA will get youthere. Know that MJoTA is a tool for visibility, dis-playing your skills as a writer and researcher.2. Keep an ongoing document of long-term andshort-term goals for career, which jobs are wanted,why you think you can be hired for the job, whichjobs you have sought, what has been the response.Always ask for feedback, if you have not been hired,find out from the recruiter or the employer why not.3. Once weekly attend a group meeting in whichexpectations for applying for jobs are reassessed,and strategies are changed, and resumes and coverletters are tailored for the jobs.4. You must be patient. If you have been unem-ployed for a long time, you are reinventing yourself.B. GETTING YOUR RESUME OUT THERE

1. Profile on Linkedin. Link to as many groups as youcan (50 is permitted), as many recruiters you canfind, link to everyone connected to the pharmaceu-tical industry.2. Resume and portfolio on MJoTA3. Resume on Monster.com, on AMWA.org4. Get on Facebook5. Join AMWA, go to events.C. BECOME A MEDICAL WRITER

1. Prepare articles for publication in MJoTA. They aredue to first of every month. During our weeklyMonday editorial meetings we discuss articles inprogress and suggestions to make them work. Weneed you to find questions, look for answers, writearticles on these answers.2. Target companies that you want to hire you. Callthe CEO, interview him. Write articles about prod-ucts marketed by the company, about their clinicaltrials, their web-sites, their presence in Africa.3. Write articles about FDA documentation, aboutNDAs, regulation in South Africa, Libya, Egypt.4. Write articles about the regulatory laws, and clin-ical trials, FDA approvals, World Bank; eg, lookthrough the clinical trials database, analyse the tri-als by indication, by country, by ethics, by therapies.5. Build a portfolio. A huge portfolio. Write abouteverything related to health, drugs, devices, biolog-ics. Write about data, because that is why medicalwriters with strong life sciences backgrounds havethe edge: they know data and they can interpret it.Write medical fiction. But write, and joyfully.By the Publisher


MEDICAL WRITER

[email protected] http://mjota.org

medical journal of therapeutics africa

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