Some observers, particularly women, might have winced in sympathy or, alternatively, wondered where she’d bought stilettos. But the three researchers, men who study the biomechanics of walking, were struck instead by the scientific implications of her passage. “We began to consider what might be happening at the muscle and tendon level” in women who wear heels, Dr. Cronin says.

How shoes affect human gait is a controversial topic these days. The popularity of barefoot running, for instance, has grown in large part because of the belief, still unproven, that wearing modern, well-cushioned running shoes decreases foot strength and proprioception, the sense of how the body is positioned in space, and contributes to running-related injuries.

Whether high heels might likewise affect the wearer’s biomechanics and injury risk has received scant scientific attention, however, even though millions of women wear heels almost every day. So, in one of the first studies of its kind, the Australian scientists recruited nine young women who had worn high heels for at least 40 hours a week for a minimum of two years. The scientists also recruited 10 young women who rarely, if ever, wore heels to serve as controls. The women were in their late teens, 20s or early 30s.

The scientists asked the heel-wearing women to bring their favorite pair of high-heeled shoes to the lab. There, both groups of women were equipped with electrodes to track leg-muscle activity, as well as motion-capture reflective markers. Ultrasound probes measured the length of muscle fibers in their legs.

All of the women strode multiple times along a 26-foot-long walkway that contained a plate to gauge the forces generated as they walked. The control group covered the walkway 10 times while barefoot. The other women walked barefoot 10 times and in their chosen heels 10 times.

It was obvious, as the scientists had suspected watching the woman during their coffee break, that the women habituated to high heels walked differently from those who usually wore flats, even when the heel wearers went barefoot. But the nature and extent of the differences were surprising. In results published last week in The Journal of Applied Physiology, the scientists found that heel wearers moved with shorter, more forceful strides than the control group, their feet perpetually in a flexed, toes-pointed position. This movement pattern continued even when the women kicked off their heels and walked barefoot. As a result, the fibers in their calf muscles had shortened and they put much greater mechanical strain on their calf muscles than the control group did.

In that control group, the women who rarely wore heels, walking primarily involved stretching and stressing their tendons, especially the Achilles tendon. But in the heel wearers, the walking mostly engaged their muscles.

That biomechanical distinction is important, says Dr. Cronin, who is now a researcher at the University of Jyvaskyla in Finland. “Several studies have shown that optimal muscle-tendon efficiency” while walking “occurs when the muscle stays approximately the same length while the tendon lengthens. When the tendon lengthens, it stores elastic energy and later returns it when the foot pushes off the ground. Tendons are more effective springs than muscles,” he continues. So by stretching and straining their already shortened calf muscles, the heel wearers walk less efficiently with or without heels, he says, requiring more energy to cover the same amount of ground as people in flats and probably causing muscle fatigue.

The obvious question raised by the findings, though, is so what? Does it fundamentally matter if a woman’s calf muscle fibers shorten and she neglects her tendons while walking, especially if she loves the looks of her Louboutins?

That question is difficult for a biomechanist to answer, Dr. Cronin admits. Aesthetics are outside the realm of his branch of science. But the risk of injury is not. “We think that the large muscle strains that occur when walking in heels may ultimately increase the likelihood of strain injuries,” he says. (This risk is separate from the chances that a woman, if unfamiliar with heels, may topple sideways and twist an ankle or bruise her self-image, which is an acute injury and happened to me only the one time.)

The risks extend to workouts, when heel wearers abruptly switch to sneakers or other flat shoes. “In a person who wears heels most of her working week,” Dr. Cronin says, the foot and leg positioning in heels “becomes the new default position for the joints and the structures within. Any change to this default setting,” he says, like pulling on Keds or Crocs, constitutes “a novel environment, which could increase injury risk.”

It should be noted, he adds, that in his study, the volunteers “were quite young, average age 25, suggesting that it is not necessary to wear heels for a long time, meaning decades, before adaptations start to occur.”

So, if you do wear heels and are at all concerned about muscle and joint strains, his advice is simple. Try, if possible, to ease back a bit on the towering footwear, he says. Wear high heels maybe “once or twice a week,” he says. And if that’s not practical or desirable, “try to remove the heels whenever possible, such as when you’re sitting at your desk.” The shoes can remain alluring, even nestled beside your feet.

GRETCHEN REYNOLDS | January 25, 2012 | NY TIMES

Irène ne se souvient plus de la dernière fois où elle a recueilli de l’eau à son robinet. A Yaoundé, au quartier Essos où elle réside, certains habitants ont presque perdu l’habitude d’ouvrir le robinet.
Les pénuries d’eau ici ont atteint des sommets. « La dernière fois, nous avons passé deux semaines sans la moindre goutte d’eau », confie-t-elle, la mine renfrognée. A Essos, on se débrouille dans des puits et autres sources qui existent encore et dans certains bas-fonds de ce quartier populeux.
D’autres secteurs comme Damase, Mimboman, Ekounou, etc. connaissent les mêmes problèmes d’eau. La société Camwater a, depuis quelques jours, déployé des camions-citernes qui parcourent ces quartiers pour essayer d’approvisionner les populations. Celles-ci se ruent alors par centaines sur les camions pour arracher un peu du précieux liquide.
La grave pénurie d’eau que connaît la ville de Yaoundé en ce moment devrait encore durer au moins jusqu’en 2013, date à laquelle les travaux de construction de la station de traitement d’eau de la Mefou devraient être achevés, selon le ministre de la Communication, Issa Tchiroma. En attendant, Yaoundé a soif.

Jean-Bruno Tagne | 24 Janvier 2012 | Le Jour |

I contacted Pr. Ayim to request an interview and without hesitation, he took some time off of his busy schedule to grant us this interview. Pr. Ayim’s book is one of the books that should be readily available in all schools and universities, home, public libraries, and bookstores across Cameroon, and in Africa. Why should you buy this book? You may ask. The answer is simple and straightforward. At last, here is a book that will help government entities, public health decision makers, Dean of medicine in universities and colleges, school principals, educators, etc. to shape a comprehensive plan to define health policies, school curriculum, as well as for self education in the areas of “Communicable Diseases.” read on…

CWN: Pr Ayim, Happy New Year 2012! and congratulations on your new book. Please introduce yourself to our readers.

Happy New Year to you to. My philosophy in Community Service and academics is captured by this quote by Einstein “The aim of education must be the training of independently acting and thinking individuals who, however, see in the service to the community their highest life problem.”–Albert Einstein.

CWN: What are “Communicable Diseases”, and how does one prevents them?

Communicable diseases are diseases that are transmissible from Person to Person, or from animals to persons, directly or indirectly. They are caused by viruses, bacteria, fungi, metazoa/protozoa termed infectious agents. The focus of Chapter one is to define and clarify these terms in contemporary ways to set the pace for the language of epidemiology.

CWN: Why do we need a book that specializes in “Communicable Diseases?

Our youths are dying in numbers due to HIV/AIDS. Cholera is resurging in developing countries. The Old are burying the young, a reversal of trend when the young should be burying the Old.  Lack of Education being at the root is the real motivation for my writing my book on “Communicable Diseases for School and Community Health Promotion”. While in Nursing School Bamenda, we had a Community outreach session in 1979 and I remember how difficult it was in Bambui to convince locals that Worms are not part of the gastrointestinal tract. From then, I made up my mind to set out to where I am (USA) and to do what I have started (write books to start a Curriculum) to address the health education problem in developing countries in a culture-appropriate , age-appropriate, and readability-appropriate manner. Health education messages must be tailored in cognizance of Cultural values. I feel it is time to take health education to our Schools as part of the Curriculum. This book is tailored to readability level from Form FIVE. Someone out there should advocate for Governments to adopt this book and make it mandatory for schools and professional institutions,community health programs, & Universities in the Nation. There is NEED! We have to start somewhere to address this problem holistically through COMPREHENSIVE SCHOOL HEALTH EDUCATION, not only lament about it. I can  provide leadership in this direction. It is coming from the HEART. Yes, our youths need vigorous and, well tailored sequential education. Knowledge is Power. I will say more to excite you during my upcoming Book Presentations and signings because I have thought this through carefully for my 20 years of teaching at Grambling State University, where I have successfully built a Health Promotion Academic Program from scratch and graduated Students in it with BS degrees. It is a communicable disease prevention journey I have started for developing countries. Stay tuned for my book presentations in your area and come prepared to take on a new challenge to Community Service through Academia. Get a copy of the book and you will be glad you did to know how to prevent 132 communicable diseases.

CWN: How many books have you written? And who should read this book?

I stayed focus for why I left Bamenda to America. As I progressed from BS Public Health Administration at Indiana to, MPH, then Ph.D in Health Education at Texas A & M University, College Station, Texas, I always sought for answers to this problem. Therefore, my first book was my Dissertation titled ” A Comparison of Cultural Perceptions between the Widikum and Chamba Ethnic groups of Cameroon”. I remember friends said it will be difficult to gather data, or get permission to do this. I stayed firm and told them I will prove them wrong. I went to Washington DC and spoke face to face with the then Ambassador Pondi, then wrote to the then Minister of Health Joseph Owona and, of course, I received a reply and permission for the study in 1992. I was in Bamenda under difficult circumstances but successfully gathered my data, thanks to overwhelming cooperation of the Fon of Bali and the Fon of Guzang and the Fon of Widikum. The main reason for braving this was that, If I left home because I saw a need, it made sense to go back conduct research and document facts for further practical work. As I finished the Ph.D in 1993, I went to the University of Buea and met the then VC, Dr. Njeuma, who slapped me on my face that Cameroon had no money to employ me, even when I chose to come on Summers. You can imagine educating yourself on no Government scholarship and be given such an answer. Believe me, I told her a few angry things.

I then made up my mind to teach in a Historically Black University in the USA, turning down offers from others, because I wanted to feel aligned with my philosophy of community service. This book, “Communicable Diseases for School and Community Health Promotion” is the second in my profession and the centerpiece for solving the problem that I diagnosed before going to America in 1984. Every person who can read this book is encouraged to so, because though written in a textbook format, it appeals to ALL and SUNDRY across the board. At some point it will be translated to other languages to reach a wider audience. The third publication is a model I developed for planning Community Health Promotion Programs titled “INDICATE MODEL”. INDICATE is an acronym for Identification and Community Assessment, Nurturing and Community Organizing, Decision-Making and Program Planning, Implementation, Coordination and Communication, Appraisal and Community Feedback, Team Building and Inservice Training, and Evaluation. This will be a chapter in the next book” Culture-Based Community Health Promotion”, which is going to hinge heavily on the findings of my dissertation and community organizing.

CWN: You said that “Health education messages must be tailored in cognizance of Cultural values.” What do you mean by that? What example can you provide us to illustrate that statement?

Yes, Health education in a community setting must recognize and respect cultural values, beliefs and practices. To change or modify behaviors, you must do it not through coercion. People want to feel dignified and participate willingly to effect change. Again, my experience in Bambui while a Student Nurse in Bamenda is case in point. We went to the Community and never went to the Fon to seek permission or alert our presence, feeling that since we were Government people, we could just  move on. The people refused to listen to us and of course before we knew, the Fon sent a message inviting us to the palace challenging our presence. We apologized. Thereafter that we had huge crowds attending our educational sessions. One person in the group, an opinion leader challenged us that Worms are normal for any human intestines and that without worms in the stomach, people will die. The people agreed with him and we never succeeded in making our point at that session about how to prevent Intestinal Worms. We went back and made more investigations about it only to discover that what they meant by worms was “Small Intestines”. The lesson here was to identify a few Opinion leaders and talk with them first and then use them to reach out to the people. This would have clarified cultural beliefs and practices of the people saving us the embarrassment we had. This will be the focus of the upcoming book “Culture-Based Community Health Promotion”.

CWN: You are suggesting that health education should start in our schools from Form Five. Why not at a kinder garden level?

Yes I agree, having a curriculum starting from Kindergarten and progressing from General to specifics with a culture appropriate and age-appropriate curriculum is great. By citing Form Five, I was taking into consideration the readability level of this textbook.

CWN: What type of leadership can you provide to our students, and educators, or other interested parties?

One thing must be clear that there are health professionals out there. Sometimes you find them joggling between many other public health responsibilities because of lack of personnel. I remember as a Nurse in Ndu, I was conducting, deliveries at the health center (Midwifery), performing Minor surgical procedures, doing community and school health talks, and screening for diseases, and making prescriptions. Prevention is in three levels-Primary, Secondary and Tertiary. Health Education/Health Promotion as a profession and academic discipline is Primary Prevention. That is prevent the disease before any person even gets it. It hinges on Behavior Modification and Behavior Change. My leadership will be to create a positive collaborative environment to ensure the profession of Health Education/Health Promotion is given its deserved recognition and is aligned with international Standards. Development of a Sound Academic BS /MS Curriculum in Health Education/Health Promotion in the department of Community Health is a must. There is a NEED. In the USA Health Education/Health Promotion is approved as a Profession by the Department of labor. It has its Code of Ethics and National Standards of Practice. Certification is at two levels, CHES for BS, and MCHES for Masters and Ph.D. In Louisiana I served on the State Grade Level Expectation (GLE) Task Force for Health Education. I enjoy being a Health Education/Promotion Professional.

CWN: The Cameroonian government will be interested in working with you if it becomes aware of your expertise. How do you envision cooperating with the branches of the government in charges of public health and education?

I am a People-Oriented Person. Collaboration in service is always the key. No one knows it all, No tree makes a forest. It is important to Utilize SWOT Analysis (Strengths, Weaknesses, Opportuinities and Threats) as guide to functioning. HIV/AIDS is killing our Youths. Cholera is resurging, other communicable diseases abound, Malaria, Schistosimiasis, intestinal parasites etc are there. Primary Prevention (Health Education/Promotion) in Schools and Communities will save lives, increase quality of life, prolong longevity, increase life expectancy, reduce health care costs, boost productivity, and empower people to make intelligent health decisions. This should be at the forefront of any health care delivery system. Good Health is Wealth.

Admin | January 11, 2012 | Cameroonwebnews|

The book is available at: http://www.authorhouse.com/  www.Amazon.com/  and Barnes and Nobles Stores. To order, go here

Pr. Martin Ayim can be contacted at this address: atakyen2002[at]yahoo.com

More about the book and the author:
Press Release Communicable Diseases for School and Community Health Promotion

A man who got a tattoo on his penis is now left with a permanent semi-erection, according to an article in the latest issue of the Journal of Sexual Medicine.

As MSNBC’s The Body Odd reports, the 21-year-old Iranian man found himself between a rock and a hard place after he got a tattoo in Persian script reading “borow be salaamat” (good luck on your journeys), and the first initial of his girlfriend’s last name (“M”).

So what went wrong during the penis-pummeling procedure?

The article in Sexual Medicine explains that a tattoo artist crafted the tattoo using a handheld needle which resulted in “bleeding from deep penile tissue for several days complicating the tattooing.”

MSNBC noted that the man had shunt surgery — which drains excess fluid from inflamed areas of the body — performed to correct the problem, but the procedure was unsuccessful.

Stiffly, err we mean strictly speaking, no surgery is necessary because, as the article notes, the man is capable of achieving a relatively normal erection and he’s not in pain. So, the patient has decided not to pursue any more corrective measures.

Jezebel wonders if the man reached his decision after he “realized that the side effect of the tattoo was that his dick looks bigger all the time. But it probably took him so long to come to that realization due to all the blood draining from his head.”

So what lessons can we learn from this poor guy’s big mistake with his little buddy? Here’s the article’s author with the good wood, uh, word:

“Considering this case, we discourage penile tattooing.”

Huffpo | 1/10/2012 | Huffpo|

Depuis leur apparition généralisée il y a trois ans, les tablettes numériques ne cessent de conquérir de nouveaux publics grâce, entre autres, à des applications de plus en plus variées. Arthur Zang, un ingénieur polytechnicien de Yaoundé, vient de se distinguer en trouvant une fonction nouvelle et capitale à un appareil considéré à ses débuts comme un gadget : celle d’aider à sauver des vies.

Car si la technologie fait des progrès gigantesques, certains chiffres font mal. Ainsi le Cameroun ne compte-t-il qu’une trentaine de cardiologues pour 20 millions d’habitants alors qu’un pays comme la France en recense en moyenne plus de 9 pour 100 000 habitants. Pire, les spécialistes camerounais des maladies cardio-vasculaires sont concentrés sur Yaoundé et Douala, les deux plus grandes villes du pays.

Un outil multifonction

Cette pénurie de cardiologues ajoutée à l‘éloignement a pour conséquence de limiter l’accès aux soins à des milliers de malades du cœur. « Quand on prescrit un examen cardiaque à un patient de Garoua (au nord du pays, ndlr), il doit venir se faire examiner à Yaoundé ou à Douala qui se trouvent à plus de 900 km », déplore Arthur Zang.

Ce jeune chercheur en informatique âgé de 24 ans a donc conçu une tablette qui va résoudre ce problème de l’éloignement. Baptisée Cardiopad, elle permet de faire transiter des données telles que les fréquences cardiaques du malade via le réseau GSM vers des serveurs de stockage. De là, ces données peuvent être transmise à un cardiologue également muni d’un Cardiopad.

Mieux encore, une encyclopédie des maladies cardio-vasculaires peut être intégrée à l’appareil du praticien afin de l’aider à faire son diagnostic. « Le Cardiopad permettra de faire passer un examen médical à des patients qui se trouvent éloignés des grandes villes et d’en faire parvenir les résultats aux spécialistes », résume Arthur Zang qui souhaite que le Cameroun se dote rapidement de centres de « télécardiologie », autrement dit de cardiologie à distance.

Encore à l’état de prototype, le Cardiopad est dans sa forme actuelle de la même taille qu’un iPad d’Apple : 10 pouces (25 cm). Arthur Zang espère pouvoir le commercialiser à un prix raisonnable, « bien moins cher qu’un électrocardiographe qui coûte 2 millions de francs CFA (environ 3 000 euros ndlr) », assure-t-il. Après avoir participé au concours Imagine Cup aux Etats-Unis, où son invention a connu un franc succès, l’ingénieur camerounais est actuellement à la recherche de financements pour commercialiser son Cardiopad, une initiative dont on ne doute pas qu’elle sera couronnée de succès.

RFI |1er Decembre 2011 | RFI

Trois facultés et 26 écoles privées
Au Cameroun, la formation en médecine est assurée par trois facultés de médecine, toutes rattachées aux universités d’Etat. Il s’agit de l’université de Yaoundé I, Buéa et Douala. A côté de ces écoles publiques, il y a une multiplicité d’autres écoles privées qui prétendent offrir la même formation. Sur ce point, le Cameroun est gâté. Et bat même les records d’Afrique. Avec 26 IPES (institutions privées de l’enseignement supérieur) qui, pour certaines, ont négocié la tutelle des universités d’Etat. C’est trop pour l’Ordre national des médecins du Cameroun (ONMC). « C’est même anormal dans un pays qui se veut moderne », tranche d’entrée de jeu le président en exercice de l’ONMC. «Tous les pays d’Afrique noire ont maximum deux à trois facs », souligne Guy Sandjon de la polyclinique de l’aéroport, en formulant une question de taille. «Comment peut-on expliquer la présence de trois fac et de 26 institutions privées ? » C’est la question centrale pour le ministère de la santé publique (MINSANTE) et du ministère de l’enseignement supérieur (MINESUP).

Constatations
L’ONMC qui est garant de la santé publique, bien qu’intervenant en aval, a décidé de voir clair sur ce qui se passe en amont. « Pour le bien de tous les Camerounais », précise Guy Sandjon. Les constations donnent du palu. On apprend que la politique de la formation médicale aux IPES ne réunissant pas les critères exigés dans ce secteur ne semble pas garantir une formation de qualité pour quatre raisons. L’insuffisance d’infrastructures pédagogiques appropriées, l’insuffisance d’enseignants qualifiés autonomes, le manque d’hôpitaux d’application autonomes appropriés et l’inadaptation entre capacités de formation et effectifs de recrutement. Ce n’est pas tout. La pratique de la tutelle académique des IPES par les universités d’Etat constitue un réel problème. D’après l’ONMC, elle conduit aux dysfonctionnements « car sources de détournement des enseignants d’Etat au profit desdites IPES, avec pour conséquence une baisse de la qualité de la formation au sein des facs d’Etat et dans l’ensemble du pays ». Bien plus, l’ONMC constate que la baisse de la qualité de la formation médicale actuelle est porteuse à terme de menaces réelles sur la santé des populations, que les IPES de formation médicale ne constituent pas une solution garantissant une formation médicale de qualité pour les besoins, et que la production potentielle au sein des IPES de jeunes médecins de formation douteuse et en quantité non adaptée aux besoins du pays est une source de problèmes sociaux. C’est un véritable coup de gueule. Guy Sandjon enfonce le clou. « Un médecin mal formé est plus dangereux qu’un gendarme armé, parce qu’il a le permis de tuer », relève-t-il. «Non à la formation sous cette forme ! », martèle le président de l’Onmc, même s’il reconnait quelques-unes sérieuses dans le lot. Au trop trois. C’est pourquoi il demande au gouvernement de fermer le reste.

Sept solutions
Cette position a été défendue par Guy Sandjon ce mercredi 23 novembre 2011, lors d’une conférence de presse qui s’est déroulée dans les locaux de l’antenne de l’ONMC de Douala. Guy Sandon était entouré par le vice-président de l’ordre national des pharmaciens, le représentant régional de l’ordre national des chirurgiens et du secrétaire général du syndicat national des médecins privés. Les trois hommes ont entièrement partagé l’argumentaire de l’ONMC et sont engagés dans le même combat. Avant le 23, le même problème était au cœur des travaux de l’AG de l’ONMC tenu le 19 novembre 2011 à Yaoundé, où le même argumentaire a été déployé avec beaucoup plus de vitalité. Pour préserver le prestige du métier de médecin, l’ONMC propose sept solutions au gouvernement. Entre autres, la suspension ou le gel d’autorisations de création et d’IPES, l’évaluation des IPES actuelles par des instances indépendantes et qualifiées, la fermeture de celles ne répondant pas aux critères et normes exigés, le renforcement des capacités des Facs d’Etat du Cameroun. D’après l’ONMC, 6400 médecins sont actuellement inscrits au tableau de l’ordre et sont pour la plupart concentrés dans deux villes, Yaoundé et Douala. Certains refusant d’aller travailler dans les villes reculées. C’est un autre chantier de l’ordre. Tout comme celui de l’exercice illégal de la fonction objet aussi de la conférence de presse susdite. Sur le dernier point, Guy Sandjon annonce une opération de force pour mettre hors d’état de nuire ces « charlatans ».

Hervé B.Endong| Jeudi, 24 Novembre 2011| Journal du Cameroun |

Il existe deux types de virus du sida, le VIH-1, majoritaire, et le VIH-2 peu fréquent. Le VIH-1 est divisé en trois groupes : M, à l’origine de la pandémie mondiale et deux autres groupes très rares, O et N. Un quatrième groupe, désigné comme le groupe P, a été identifié en 2009 par une équipe française chez une patiente originaire du Cameroun.

Jusqu’à présent, les seuls cas rapportés d’infection par le VIH du groupe N l’ont été chez des patients vivant au Cameroun.

Le groupe N a été identifié pour la première fois en 1998 dans ce pays chez une femme qui a développé le sida. Sur les plus de 12.000 personnes infectées par le VIH vivant au Cameroun testées, seuls 12 cas d’infection par un virus du groupe N ont été identifiés.

Le Pr François Simon (hôpital Saint-Louis, Paris) et ses collègues du Centre national de référence du virus de l’immunodéficience humaine de Rouen (ouest de la France) rapportent vendredi dans la revue médicale The Lancet le cas d’un homme de 57 ans, vivant en France, chez qui une infection par le groupe N a été diagnostiquée.

Admis en janvier dernier aux urgences de l’hôpital Saint-Louis, l’homme rentrait du Togo.

En retraçant l’histoire de sa vie sexuelle, les médecins estiment que l’infection a “probablement” été contractée lors de rapports sexuels au Togo, “ce qui suggère que les virus du groupe N circulent désormais hors du Cameroun”.

Pour les médecins, l’identification de ce cas est particulièrement importante en raison des symptômes sévères présentés par le patient et de la chute précoce de son taux de CD4 (marqueur de l’immunité).

Une combinaison de cinq médicaments antirétroviraux a montré une bonne efficacité initiale, mais un suivi immunologique et virologique à long terme est nécessaire, selon les médecins. -

ANP/AFP | 25 Novembre 2011 |

Together, they weigh 9.7 pounds.

They are two baby girls born in a miraculous delivery in this impoverished Cameroon village. They both have arms and legs but they are joined at the chest and abdomen.

The parents desperately search for a way to separate their newborns. Even in sophisticated hospitals, the operation is risky. But here, in Cameroon, so many forces act against them.

Money and access to health care are two obvious obstacles.

But then, there is superstition. And plain old indifference.

Evaristus Samba, 29, the girls’ father, wipes tears from his eyes as he pleads for aid from the international community.

“We are mere peasants and can’t even afford to eat healthily daily.”

Doctors are battling with limited resources to keep the girls alive. Though they are artificially fed with tubes, they are healthy and active, nurses say.

An ultrasound indicated that Glory Njweng, 23, was having only one baby. The test was faulty, and neither she nor the doctors were prepared for her to deliver twins, much less conjoined ones.

“It is only the Lord Almighty who keeps me alive” to deliver the children for whom she now is washing clothes. “I feel terrified when thinking about October 10, when I put to bed these babies.”

Tugi, in northwestern Cameroon, is home to about 2,000 people, mostly farmers and cattle ranchers who live below $1 a day. Here, traditional practices and beliefs hold sway.

News of the conjoined birth struck immediate fear. This was a bad omen for their village, some feared.

Sometimes, conjoined twins often are killed immediately after birth. Village leaders say they bring bad luck; some blame poor crops on “strange births.”

Even some of the attending staff fled the small hospital room when Njweng’s babies were born.

Such practices are fading, says Bah Elvis, a village healer from nearby Mbengwi. But long-held beliefs die hard.

Conjoined twins are rare in Cameroon, and rarer still is their separation.

The first known case involved the babies Pheinbom and Shevoboh, born in Babanki Tungo, who were separated in Saudi Arabia in 2007. They were joined at the chest, abdomen and pelvis, and had one leg each.

The Presbyterian hospital where the Tugi twins were born is one of the biggest in Cameroon, but it is ill-equipped for an operation of such complexity.

It has been without a consistent source of electricity since it opened in 1964. Doctors use kerosene lamps in delivery wards, nurse Rose Adeneng says, and kerosene often spills out during deliveries and surgeries.

Hospital officials also believe they have suffered from government neglect.

Hospital Administrator George Fonkem Tankem says travel by road in the region is not easy; many women prefer delivering at home than risk dying on their way to the hospital.

The 235-mile journey to the capital, Yaoundé, would be perilous for the twins, he says.

But Njweng and her husband are clinging to hope. The babies’ birth was nothing short of miraculous, she says. God gave her life, she says. Now, she prays, her girls will get the same.

Watch the video:

But Miller and her husband started running, and just kept going. They ran part of the race and walked the second half as her contractions started. It took the couple 6.5 hours to finish. She said she grabbed something to eat and the two headed to the hospital.

Monday, 10 October, 2011

Related articles

• Pregnant Woman Finishes Marathon, Delivers Baby Girl (abcnews.go.com)

A member of a support group for women living with HIV shares her story with UNITAID Chair Philippe Douste-Blazy. (This is not Beatrice).

Beatrice didn’t want us to take her picture. Neither did she want me to use her real name. Most of her friends and family don’t even know she’s HIV positive — the stigma here against people living with HIV is strong. Still, she was brave enough to tell her story to a room of journalists and health officials, including the chair of UNITAID, Philippe Douste-Blazy.

Beatrice is 30 years old and the proud mother of a 13-year-old and devastatingly cute 16-month-old baby. In 2002, Beatrice was diagnosed HIV-positive. She quickly went on anti-retroviral treatments, which for her meant taking two pills once a day. Every month, she would travel to the local health center to pick up the medicines. She stuck with that routine for eight years. But after she delivered her second baby — who was healthy and HIV-negative — she decided to stop her treatment. As she tells it, she was feeling perfectly fine and didn’t see the need to keep up with her routine.

That turned out to be a very big mistake.

Two months after she quit her treatment, she fell very ill. Skipping two months of ARV treatments raises the possibility that the virus may develop a resistance to the medicine. That is exactly what happened to Beatrice. Her doctor told her that if she wanted to live, she would need to go on so-called “second-line” ARVs.

She was able to get on the second line drugs, and after one month she began feeling better. But instead of taking two pills a day, she now has to take six. If she develops resistance to the second line, the results could be catastrophic. Third-line drugs, while they do exist, are not available in Cameroon. If for some reason she misses a month or two of treatment, the virus could become effectively untreatable.

Beatrice is committed to her second-line drug regimen, but circumstances outside her control could interrupt her treatments. In Cameroon, “stock outs” of drug supplies are an ever present threat. Beatrice lives with the stress that she may miss a treatment through no fault of her own. She fears what that might mean for her children.

Beatrice’s story is moving on a personal level. But as a public health challenge, her circumstance illustrates a huge gap in the way governments and donors have historically approached people living with HIV. The second-line drugs that Beatrice takes daily are several orders of magnitude more expensive than traditional, first-line ARV treatments. The problem is that as more people access first-line treatment, there will be more opportunities for people to develop resistance to that first line. Donors and governments in the developing world simply can’t afford that kind of outlay.

It costs about $70 to $100 dollars per patient per year for first-line ARV treatment in the developing world, but $700 to $1,000 per patient per year for second-line treatment. For resource-poor countries, the costs of expensive, second-line drugs is a huge barrier to providing care. Here in Cameroon, there are about 95,000 people on ARVs, about 5 percent of whom are on second-line treatment.

The government estimates that there is a further 150,000 people who could be on treatment but are not because they do not know their HIV status. As the government and NGOs get better at reaching HIV-positive people with treatment, the number of people who will require second- and third-line treatments may sharply increase. If you count on a first-line treatment failure rate of about 5 percent, that means the sum that government and donors would have to set aside for second-line treatment would be impossibly high.

UNITAID Chair Philippe Douste-Blazy at a drug warehouse in Yaounde, Cameroon

This is where UNITAID comes in.
One of the reasons that the costs of second- and third-line treatments are so high is that the drug manufactures hold expensive patents on the drugs. On the one hand, this is reasonable enough: drug manufacturers invest a great deal into R&D and deserve a decent return on their investment. On the other hand, if costs don’t come down, several thousand people living with HIV who require second-line treatment will not be able to access it.

UNITAID’s brand new “patent pool” seeks to bridge the moral imperative to provide low-cost drugs to patients and drug companies’ need to see a return on their investments. Drug companies who participate in the patent pool hand over their patents to UNITAID, which makes those patents available to generic drug manufacturers. Part of the deal is that the generic drugs can only be sold in lower-income countries, which helps to preserve the value of the patent. UNITAID then pays a modest royalty to the original patent holders. The fees that the patent holder receives are smaller than what they would otherwise earn on the sale of their drugs in rich countries, but the patent pool opens markets for their drugs where it would otherwise not exist. The difference is between receiving a small royalty or simply being priced out of the market entirely.

The pool was officially launched last month when Gilead Sciences turned four HIV drug patents over to UNITAID. They need other major drug manufacturers like GlaxoSmithKline and Johnson and Johnson to get on board if it is going to really work.

This is a tall order, but it could mean the difference of several thousand lives that would otherwise be needlessly wasted.

Mark Leon Goldberg | August 31, 2011 | Writer for UN Dispatch

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