Cholera and health communication

Health communication is generally seen as one of the duller departments within the medical and public health enterprise. The image is conjured of dour health professionals, endeavoring to improve the understanding of health-related issues among the recalcitrant general population with (yet more) well-intentioned posters and pamphlets. But it can and should be conceived differently. Health communication is not the monopoly of health experts. We all do it, to some extent: we repeat what we hear about what is healthy or unhealthy, and tell each other what behaviors or consumables to embrace or avoid. Commercial interests barge in. Distorted or self-serving communication is also communication, as are rumor, gossip and hearsay. Every message from the Ministry of Health is set in a world of countermessages. And the release or suppression of health information -- particularly about threatening conditions -- can have all sorts of motivations.

I was reminded of this when reading about recent events in Mozambique. In the northern province of Cabo Delgado, cases of suspected cholera raise rumors of government and health care efforts to intentionally sicken the local population. The Diario de Mocambique, the daily paper from the capital Beira, reported that the latest uprising was sparked by the death of a mother and her children from some sort of diarrhoea-related disease. Relatives of the deceased believed that these were cases of cholera, and that cholera had been spread by local authorities and backed by the ruling Frelimo party. Others joined in the melee. Police and reinforcements were called: injuries, deaths and arrests ensued. This too is health communication, where health issues may be symptomatic of deep distrust between citizens and governments.

When the foreign funded HIV programs pull out

For those who were not fans of the former President George W. Bush's tenure, The President's Emergency Plan for AIDS Relief or PEPFAR was his only positive contribution to global affairs, a successful utilization of 'soft power' if there ever was one. When access to antiretroviral therapy was almost impossible for your average person in the developing world, PEPFAR provided entree to HIV drugs and services, at least in the selected PEPFAR countries. The program by now can boast of many achievements, particularly the sharply increased access to AIDS drugs even in the most disadvantaged settings. Millions of lives have been saved. But as I mentioned in an earlier post a couple of years ago, this is a fragile, dubious, and non-sustainable relationship in the long term. HIV requires lifelong treatment, and it is not healthy to have your existence depend on the decisions of a foreign government, especially an economically sputtering and lurching superpower.

Now it seems that the chickens are coming to roost. PEPFAR has announced that it will no longer be funding health NGOs in South Africa that provide HIV/AIDS services. HIV positive patients are stranded and scrambling to find alternative sources of care. This generally means joining the long lines in the highly challenged public health care sector. The potential for treatment interruptions abounds. This unwelcome development has not gathered much attention in the international press, although the AIDS Healthcare Foundation has weighed in, launching a press release stating that President Obama's cutting of Global AIDS Funding is 'shameful.' Well, yes and no. The shame should at least be shared by the South African government, in particular the Department of Health, whose ultimate responsibility it is to provide reasonable access to HIV/AIDS services for citizens who need them. It is not the sort of responsibility you can outsource to foreigners in perpetuity.