It’s nice to see a mystery solved. We just saw some major panic in Indonesia about a treatment for a neglected tropical disease. The Jakarta Post reported this morning that, after a mass administration of drugs to fight lymphatic filariasis, “those treated by the drugs started to die or fall ill by the hundreds.” They ran the story under a headline that said “Did Disease-Fighting Drugs Do More Harm Than Good?”

 The news has been spread by worried Indonesian bloggers, and no one seems to believe the denials from the Indonesia Ministry of Health. According to the Post, “Health Minister Endang Rahayu Sedyaningsih was quick to deny the deaths were caused by the drugs, saying only that some underlying diseases were the probable cause.”

If it’s true that the treatment, a combination of the drugs DEC and albendazole, is dangerous, that’s bad stuff. Lymphatic filariasis is also known as elephantiasis and it causes serious suffering and social stigma. A billion people are at risk for it. Treating it is important work.

It turns, out, however, that DEC and albendazole actually carry some unpleasant side effects, especially for people who are infected. In particular, headaches, nausea, and fever - often quite severe.  They’re not long-lasting, or dangerous. Just very unpleasant.

All of this points to the importance of educating people about the treatments they are getting. If there had been some clear discussion of the likely side effects, people would have expected their symptoms. A mass hysteria could have been stopped before it began.

There are a lot of rumors coming out of Ukraine right now about a new form of swine flu, a brand new illness, or some kind of virulent pneumonia. I suspect it’s no more than swine flu with complications, but it’s causing some major panic in Kiev.

Britain’s Daily Express newspaper has the terrified tabloid version. They report that “A cocktail of three flu viruses are reported to have mutated into a single pneumonic plague, which it is believed may be far more dangerous than swine flu. The death toll has reached 189 and more than 1 million people have been infected.” The New York Times has a slightly more nuanced report. They identify the mystery illness as swine flu and quote a WHO official who says that “Early findings are that serious cases mounted because the sick avoided hospitalization until their illness was dangerously advanced, stockpiles of Tamiflu were locked in centralized locations and the supply of ventilators fell short.”

I suspect that the WHO and the New York Times have it right. There are a lot of barriers to access to health care in Ukraine, under-the-table payments being one of the biggest. I can well imagine people refusing to go to a doctor until their lungs were past saving. Avian Flu diary agrees, attributing the unusual severity to viral hemorrhagic pneumonia as a complication of swine flu. They also have an enlightening comment at the bottom of their post from a commenter in Ukraine watching the situation unfold.

Secrecy is not helping the government of Ukraine here. In a nation with a history of cover-ups – Chernobyl being the most famous – the population is quick to panic when they sense that they’re not getting the real story. Getting the real story out as fast as possible and backing it up with access to medical care – is the only way to stop the panic.

The United Nations Population Fund organized a high-level meeting in Istanbul this week, calling attention to the economic benefit of supporting family planning and the rights of women. The meeting focused on the challenges that face Central Asia and Eastern Europe as the countries in the regions try to meet the Millennium Development goals that relate to maternal mortality. The meeting issued a progress report that discussed the challenges facing Eastern Europe and Central Asia and the progress that has been made so far. Here’s the good news:

• Maternal mortality has fallen by half, from 51 per 100,000 live births to 24
• Fifteen years ago, more pregnancies resulted in abortions than live births; the ratio has now decreased to 494 abortions to 1000 births
• Antenatal coverage and skilled birth assistance is widespread

They also signed a statement reaffirming their commitment to improving women’s health. It was pretty much the usual stuff – access to reproductive health care, reducing maternal mortality, investing in women’s health and education.  These are all important and valuable, but not especially surprising.

A few of the provisions did surprise me. The statement recognized the importance of the private sector, but also recommended that “that ongoing health reforms focused on decentralization and privatization should safeguard access for the poor to quality sexual and reproductive health services including maternal care, family planning, and reproductive health commodities.” They also “recognize the existing inequities in access and quality of reproductive health services.” This focus on making sure that health sector reform promotes equity struck me as both unexpected and a very good thing.  

Amnesty International issued a new report today accusing Israel of unjust division of water resources. Or, as they put it, “denying Palestinians the right to access adequate water by maintaining total control over the shared water resources and pursuing discriminatory policies.” They state that Israel uses more than 80% of the Mountain Aquifer, one of many water sources for Israel and the only one for the West Bank.

The report goes on to say that:

In the Gaza Strip, 90 to 95 per cent of the water from its only water resource, the Coastal Aquifer, is contaminated and unfit for human consumption. Yet, Israel does not allow the transfer of water from the Mountain Aquifer in the West Bank to Gaza…Stringent restrictions imposed in recent years by Israel on the entry into Gaza of material and equipment necessary for the development and repair of infrastructure have caused further deterioration of the water and sanitation situation in Gaza, which has reached crisis point…Over more than 40 years of occupation, restrictions imposed by Israel on the Palestinians’ access to water have prevented the development of water infrastructure and facilities in the OPT, consequently denying hundreds of thousand of Palestinians the right to live a normal life, to have adequate food, housing, or health, and to economic development…

This is ugly stuff, and it doesn’t exactly bode well for peace efforts.

Israel does deny the charges. Reuters reports that “Israel's water authority called the report 'biased and incorrect, at the very least' and said that while there was a water gap, it was not nearly as big as presented in Amnesty's findings.”