Health News of Wednesday, 27 May 2009

Source: Hayford Siaw

Institutional Inertia

Institutional Inertia

The World Health Organization on October 30, 1998, announced the creation of an affiliatedorganization, that was named, Roll Back Malaria. The reductionof malaria in Africa by 50% within 10years was the stated goal of this new organization.

Dr. Donald Roberts, Ph.D, an entomologist, Professor of Tropical Public Healthat the Uniformed Services University of the Health Sciences in Bethesda,Maryland, stated, "The Roll BackMalaria program, a partnership of WHO and UN organizations, has been an abysmalfailure. Since the RBM founding in 1998, deaths from malaria havesteadily increased". This statement was taken from an articleshowing a graph with a projection of actual malaria deaths at 30% increase overthe baseline rate just 10 years ago.

The question is why the increase instead of the projected 50% decrease inmortality over the life of this project? Let us examine the missionstatement attached to the press release announcing the inception of thisprogram. It starts out on the first page with the claim "simple prevention and control methodshas shown startling results: in trials conducted in the Gambia, Burkina Faso,Kenya and Ghana, the use of bed nets, which are treated with pyrethroidinsecticide, was shown to effectively protect sleeping children from malarialmosquitoes, resulting in dramatic reductions in deaths among children underfive years of age. Deaths were reduced by average of one fourth in thesemega trials". Perhaps the term "dramatic" inthis instance is shall we say; "dramatic", in its context, this methodis much ado about nothing as in ineffective.

Let's see what other interventions, the Roll Back Malaria mission statement hasfor our consideration. "Simpler and more effective means of administeringmedicines" and the encouragement of "new anti-malaria drugs andvaccines", it sounds like a defensive strategy. First you hide undera net to avoid the mosquito, if that does not work; you take a pill to keep themalaria parasite from killing you. As in an American football expressiongoes, "the best defense resides in a goodoffense". Why not deep six the little suckers and be done with it.

The reference to development of "new anti-malaria drugs andvaccines" is a fools errand, and overlooks the incredibly complexnature of the malaria parasite. Some 9,000 genes. This parasite hasthe incredible ability to adapt to anything. Mr. Robert Desowitz, amedical research entomologist in his book, MALARIA CAPERS says, the search fora malaria vaccine has gone on for generations, and none will ever be found, tobe effective. This research he says is for the sole purpose of gettinggrant money for universities, from wealthy individuals, foundations andgovernments. The cause is noble, however the goal is unobtainable. Meanwhile resources that could be applied to the elimination of this diseaseare wasted by academics. Even Bill Gates is a victim of this scam, havingpoured untold millions into this effort.

The failure to eliminate malaria is more than a humanitarian one, it also has adramatic impact on economic development as well. Included in this RollBack Malaria mission statement is a quote from Jeffrey Sachs, Professor atHarvard. and says in part "We andother groups of economist researchers are trying to determine the consequencesof malaria on economic development" and "Our findings arestriking. They point to Malaria as a major impediment to economicdevelopment" enough said. I once did an internet search andpulled up a colored graph of the poorest countries on planet earth and acorresponding colored graph of the countries with most malaria. To myamazement they were identical. In the arena of public health, thefailure to eliminate malaria in the world is by far the greatest failure. It is not the failure of technology; it is a failure of leadership! The Westhas proven the technology is available. The Will to do somethingmeaningful about this scourge is absent.

Let us examine the nature of the World Health Organization, the organizationthat has taken the lead as "expert" to the 80 or so sisterorganizations known as NGO's or Non Governmental Organizations. The WHOalthough it is a quasi governmental organization, is by nature a not forprofit, additionally there is a kinship since they both provide publicservices. Any organization is of course a simple legal instrument, so todetermine the personality of an organization you have to examine the personalityprofiles of its leaders.

A person known as a bureaucrat is in charge of this complex multi facetedorganization, the nature of a bureaucrat is to keep steady the course of theorganization. Stifling anyone who shows creativity or initiative;otherwise how can this organization maintain its identity, if it allows any creativeactions on the part of its employees or anyone else for this matter? Ifany changes are made it is a committee that makes them. Of course in therecorded history of mankind there is no record of a monument ever being erectedto a committee; regrettably, only to individuals.

An entomologist is thenext personality type that needs examination. An entomologist is a personthat studies insects, usually insects that transmit diseases, the WHO in thiscase would employ an entomologist that knows more than a person wants to knowabout malaria mosquitoes, mating habits etc. However anentomologist has no training in the art and science of killing mosquitoesonly to identify them. The problem lies in the perception in their mind thathe is an expert in this endeavor. Hence this is how you get arecommendation for the use of bed nets, an intervention that is only 25%effective. Then you have the medical doctors, with their prescriptionspads ever at the ready, to write a prescription for whatever ails you. Inthis case a prophylactic pill to keep the malaria you already have from killingyou or modifying the disease in the event you get it.

The people who suffer from this misfeasance are of course, the victims ofmalaria here in Africa. Additionally thenon-profit organizations that depend on the ‘’sound technical guidance’’ fromWHO, in their attempts to obtain value for their contribution to the welfare offellow humans.

The Solution, eliminate the mosquito! this is the only method thatwill free Africa from this scourge. Byeliminating the mosquito means to suppress the population to such a lownumber there will not be enough mosquitoes left to maintain thetransmission cycle. The elimination of the transmission cycle can beaccomplished in about 30 days or so in Ghana. The elimination of theparasite from the human body will take at least two years. However therewill be no more new infections in the population, perhaps only re-lapses of oldinfections. The method used to obtain this goal, is what is called in theUS,"space spraying". that is the treatment of the atmosphere atnight over a large area, when the malaria mosquito is out and about,flying. However the objection to this form of treatment has beencost. Admittedly it has been historically expensive. However overthe past 10 years, in the USthere have been dramatic advances in reduction of costs through improvements ofinsecticide dispersal systems and application methods. These improvementshave made this process affordable for developing nations and Ghana should goin for it!

Hayford Siaw

Executive Director – VPWAGhana (www.vpwa.org)

+233 24 3340112