What happened to South Sudan?

Posted on February 1, 2014 by Tenayistilign

I had several friends from southern Sudan while in medical school in Jimma, southwest Ethiopia. It was back in the early 90s during the second Sudanese civil war that lasted from 1983 up until the signing of the Comprehensive Peace Agreement in 2005 that paved the way for the creation of the newest nation in Africa, the outcome of which was threatened after the death rather unexpectedly on July 30, 2005, of Dr John Garang de Mabior, the charismatic leader of Sudan People’s Liberation Army/Movement (SPLA/M).

Those were trying times for many of my southern Sudanese friends who were the lucky few who got scholarships to attend 2 year pharmacology and related health science fields in what is now Jimma University after surviving extreme harsh conditions to escape to refugee camps in border towns in Ethiopia. I remember the heated debates about the civil war, its tragic cost on human life, the necessity of the struggle for justice and freedom. Almost every one of them had lost a brother, a sister, a parent, a close relative or a friend. Some perished in the wilderness trying to escape the brutality of the war. All had hope that one day there would be a better Sudan or if not, an independent South Sudan where its people will have the chance, if you will, of determining its fate. The war would continue long after I finished medical school but even then, back in the 90s, there was a feeling that it lasted far too long and had claimed far too many, over a million, lives. The southern Sudanese that I met in Jimma never identified themselves as Dinka or Nuer but as the oppressed people in Sudan. Whether Dr Garang wanted to see a fair but united Sudan where its entire people are all treated equally but not necessarily as an independent states is better left to scholars on Sudan politics for we will never know for sure what the outcome would have been had he lived to see the peace agreement. General Salva Kiir skillfully put together all the different interests and led to South Sudan’s independence, the newest country in Africa with riches such as oil but lacking even the very basic infrastructure. With its capital as Juba, the Republic of South Sudan became officially an independent country on July 9, 2011 following a referendum that passed with 98.83% of the vote. That was a day that put smiles on many faces such as mine, driven in many ways by an early exposure to the plight of its people through close friends in Jimma some of whom would advance in their studies to become doctors.

It will only take two years before the country would go up in flames in another civil war manufactured in South Sudan itself by the same leaders who spend their lifetime fighting for justice and independence yet with suppressed hunger for absolute power. The Kiir-Machar civil war started after the former, the president of the republic, fired the later, the vice president in what appears like a power struggle within the ruling party claiming tens of thousands of lives and displacing hundreds of thousands. The conflict had ethnic dimension pitting the Dinka and the Nuer, the largest and second largest tribes in the country belonging to the president and former vice president. I don’t know where my friends are today but I know some of them went back to South Sudan after independence but to think about the possibility that any of them, their families, relatives or friends may have died in this senseless war, drowned in the Nile trying to escape to safety, or making another trip to the all familiar refugee camps in neighboring countries pains me.

After all when Jon Garang said, “This peace agreement signals the beginning of one Sudan regardless of race, religion or tribe,” he may have foreseen the challenges of South Sudan as an independent country. In Sub-Saharan Africa, independence is not always a solution for injustice.

In a continent with no culture of resolving conflicts peacefully, how can one dream of one South Sudan regardless of tribe or different political opinion?

For God’s sake, leaders of South Sudan come to your senses and stop the misery of your people and put a smile on our faces.

Posted in Opinion | 1 Comment

A piece of my day

Posted on January 21, 2014 by Tenayistilign

Addis Ababa, 1998.

He looked much older than his 57 years. 

It was easy to note how emaciated he had become.  He was pale. His breathing was shallow. His belly was distended. His legs were thin, barely any muscle on his bones.

His daughters and his wife were standing by the bed side.

They had a resigned look with swollen eyes and dried tears.

 “Yimarih,” he said.

That was his last word.

His liver had failed from Hepatitis C virus and repeated doses of Hagenia Abyssinica or Kosso, the word used for the medicinal plant that many Ethiopians of my generation used for intestinal worms which is quite frequent as a result of consumption of raw beef or minced raw beef marinated in spiced chilli powder. The food tests so good most would risk having worms than cook it. The use of plants for medicinal purposes is very common place and wide spread in Ethiopia, a country endowed with diverse resources with different habitats and vegetation, knowledge often passed by word of mouth from generations to generations. Hagenia Abyssinica is one such plant commonly used for medicinal purposes especially in adult tapeworms but without much appreciation of its toxic effect on the liver particularly when used in large doses and multiple times.

Liver disease and liver cancer are very common in Ethiopia and other developing countries. Aside from the toxic effect of herbal medications, Hepatitis B and C viruses have high prevalence.

He suffered with many complications that required hospitalizations.  Treatment for Hepatitis C virus was not available. Not too long ago he survived a major bleeding episode.  During his last few months, he had to have 3-5 liters of fluid removed from his belly almost on a weekly base to ease his shallow breathing and distress.

“Yimarih (bless you),”he uttered after I sneezed; his voice was very faint.

It didn’t register in me until I sat down in the nursing station to write his death summary. It was overwhelming. I wasn’t feeling well myself with common cold but nothing compared to his ordeal.

He died of complications of liver disease; he was a good person, I wrote.

WHO Key facts

Hepatitis C is a liver disease caused by the hepatitis C virus.

The disease can range in severity from a mild illness lasting a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer.

The hepatitis C virus is transmitted through contact with the blood of an infected person which can occur through injections with contaminated syringes and needle-stick injuries, injection drug use, being born to a hepatitis C infected mother,  sex with an infected person, receipt of contaminated blood transfusions, blood products and organ transplants

About 150 million people are chronically infected with hepatitis C virus, and more than 350 000 people die every year from hepatitis C-related liver diseases.

Hepatitis C can be treated using antiviral medicines.

There is currently no vaccine for hepatitis C; however, research in this area is ongoing.

Posted in Uncategorized | Leave a comment

The Role of Egypt in Early Civilization

Posted on January 9, 2014 by Tenayistilign

BY Ruth Kebede, BSc

History opens the window in to the past which enables us to examine key events that defined and shaped the present and even perhaps the future such as the medieval monolithic rock-hewn churches in Lalibela, the Obelisk of Axum in Ethiopia. It is with that intention that I chose to explore the role of Egypt in early civilization. It is also personal to me. Egyptians drink from the Blue Nile that originates from Lake Tana in Ethiopia. Ethiopia is also constructing the Grand Renaissance Dam which when completed will be the largest hydroelectric power plant in Africa and is expected to benefit not only Ethiopia but the whole region.

Along with Mesopotamia, Egyptian society played an early role to shape our world but unlike Mesopotamia, the great civilization of ancient Egypt didn’t have to deal with frequent invaders. The surrounding deserts protected Egypt and its civilization and preserved some of our fascination with Egypt such as the pyramids, the mummified tombs, and other artifacts.

The Old Kingdom, the period between 3200-2260 B.C.E, saw the rise of the pharaohs, who ruled Egypt with great authority and oversaw the beginning of Egyptian civilization. This period was orderly and had the semblance of a smoothly running kingdom. To explore this civilization, I would like to point to two important historical facts about early Egypt that fascinates me: the Pyramids and the process of mummification but first let me start with the Pharaohs.

The Pharaohs were kings of Egypt. They cultivated this mythical relationship with God that they often regarded themselves as Gods in flesh. They had such great authority in ancient Egypt that they build immaculate pyramids to preserve their body for use in the afterlife. In the process they mastered the techniques of mummification and the mathematics of building pyramids. Here we see the beginning of the relationship of state and religion. The pharaoh used this mythical power to rule over the vast land of Egypt and brought civilization which raises one of the fundamental questions in modern society, the debate over the role of government in peoples’ lives. Did the people of Egypt begrudge the intrusion of the Pharaohs in their ways of life? That I can’t answer but a strong mythical kingdom lead by the Pharaohs did bring about civilization to ancient Egypt. That much we can be certain and such one powerful Pharaoh was Ramses the Great who ruled Egypt between 1301-1234 B.C.E. Ramses II is acknowledged in the Old Testament as the pharaoh during the Exodus of the Hebrews. He constructed magnificent temples and statues. It is noted that he build great residence to fortify the boundaries of the land and what was known as the city of Ramses. He was so powerful that his temple at Abu Simbel had four colossal figures. The relationship of the pharaohs to God is well described in the Pyramid Texts which were discovered in 1881. These texts promoted the resurrection of the Pharaoh from the dead. There are documentations that indicate Pharaoh’s relationship to their creator. Some incantations taken from the pyramids of Pepi I, a king around 2400 B.C.E, for example shows prayers for admittance to the sky and the sky Goddess. Egyptians also believed that in death they can be judged by the God of the underworld (Osiris) on the basis of truth and moral purity. This is well described in the Book of the Dead. These texts reflect the struggles of early Egyptians to define morality through what is called negative confession.

One can infer that in early Egypt a strong and powerful kingdom was critical to establish a system of governance where the citizenry had a set of rules to abide by even if they probably had no role to shape it. I also suspect this mythical power displayed by the Pharaohs may have avoided any potential rivalry for power and helped create a stable system of governance with predictable continuity. In the process, early Egypt stumbled in to this exotic construction projects: the pyramids which is one of the Seven Wonders of the World and are main tourist attractions of modern Egypt playing a significant role in its economy. How did the early Egyptians engineer the construction of the pyramids? Let’s not go anywhere but look at the Great Pyramid of Cheops which occupies 13 acres of land, 481 feet high, which is composed of 2.3 million stone bricks. These pyramids took 20 years to build and hundred thousands of people to work at it at a given time that involved harvesting stones from the Nile, moving them by way of making causeway which in itself is a magnificent work. I want to bring your attention to the architects of this massive project that withstood the test of time. Here we see mathematics, geometry applied to perfection over decades. This wasn’t only a reflection of civilization in math and architecture but also the art of social mobilization perhaps through creating this mythical relationship of authority and belief.

The contribution of Egypt to early civilization doesn’t stop with the pyramids. Let’s now explore the mummification technique that they perfected. The mummies are a treasure left to us to learn more about the people of that time. For example it was noted that the mummy of Ramses the great was well preserved and led to the clue as to his medical ailments such as acne, tuberculosis and poor circulation of the blood. It’s estimated that he lived in to his 90s, an achievement in of itself given low modern day life expectancies.

It is interesting to note how much the early Egyptians had perfected understanding of human anatomy. They have several techniques but one most frequented involved removing the brain contents through the nostril using crooked pieces of metal and having done that they use drugs to clear and rinse the reminder of the skull. They use sharp instruments such as Ethiopian stones to take out the whole contents of the abdomen and then they cleanse it with palm wine and infuse it with pounded aromatics. It doesn’t stop there; they use hydrated sodium carbonate or natron for several days to cover the entire body.These are early day scientists, or pathologists one can say. For example it is written that covering the body with hydrated sodium carbonate must not exceed seventy days. This informs us that they have experimented to come up with a formula that worked. Sixty nine days perhaps didn’t work nor did seventy one. It is also written that there were cheaper or less elaborate ways of mummification that doesn’t involve incision or disemboweling or injections in to the bowl but rather using oils made from cedar- tree. This is a reflection of a thriving scientific and business community in early Egyptian civilization where arithmetic, medicine, economics, religion and art are all blended.

In summary Egypt, like Ethiopia, has played a significant role in early civilization through their geometry and mathematical prowess which makes we Africans all proud.

Reference
1. A. Daniel Frankforter and William M. Spellman, The West: A Narrative History, Vol. I: to 1660, 3rd Edition.
2. Perry M. Rogers, Aspects of Western Civilization.Volume I: Problems and sources in History, Seventh edition.

Ruth Kebede graduated with honors from Cleveland State University.

Posted in History | 1 Comment

The Small Changes That Can Change You

Posted on January 2, 2014 by Tenayistilign

By Dr. Bikat Sahle

As we excitedly and boldly dive into 2014, most of us are filled with new inspiration, high hope, and energy to make the year our best yet in every aspect of our lives. We want to work towards living a healthy life, strive to achieve our impassioned goals, and see our dreams materialize. We become motivated to be physically fit, mentally strong, and strategically efficient to balance all areas of our lives so we can follow the path towards living our life to the fullest.

Usually by February (if not by second week of January) this passion and inspiration fades and our living will return to the usual humdrum existence. As the energy and motivation diminishes, the sight of the big picture is lost and we are back to where we were last year. This article aims to suggest the small changes that we can make to keep the flame of our inspiration aglow and to sustain our energy and motivation throughout the year. These are basic self-care strategies that are within our control and can help us persist in pursuing healthy and goal-directed lives.

1.Take time to sit down and right your goals that you envision to accomplish in the new-year, break them into achievable small goals; then ask yourself what the anticipated barriers are, as well as having strategies to overcome those barriers. Ask honest questions, of what made it difficult for you to achieve some of your goals in the previous year and what you can do differently this year. Be daily committed to the changes you want to see in your life.

2.Remember the 21-day rule. When we make healthy behaviors repetitively long enough (exercise, healthy eating, reading, etc.), they become a habit engrained in our brain, and so they become much easier for us to do them. There is scientific data supporting the 21-day rule, that is when you repeat a behavior for 21 days, it becomes a habit. Thus, be determined to make the extra effort in the first three weeks to not miss the behavior realizing that once it becomes a habit, it will be an easy ride. This also means that once you develop the habit, you have to be careful not to let them slip when a distracting event occurs in your life. When that happens, have a plan to get back up.

3.In your daily duties list, include getting physical exercise as one must-do activity. The numerous health benefits of physical exercise in preventing physical ailments, helping in the recovery process of illness, strengthening one’s physical and mental stamina, counteracting with negative effect of stress, etc, cannot be overestimated. You can always start with just 20 minutes of daily exercise. Even those with a very busy lifestyle can find creative ways to incorporate exercise into their daily routine. You can be very creative with this. Remember, when you exercise, you can be more energetic and efficient to accomplish your other daily tasks.

4.Watching your diet. Today more than ever, we are learning about the connection between what we eat and our physical/emotional health. Making small changes of adding more fruits and vegetables to our diet and eating less fatty foods can be highly beneficial to our health. Some even advocate plant based diet. Making a habit of healthy eating can make the normally unpalatable foods more desirable. Eating healthy also does not mean starving yourself, which is equally destructive to the body. Moderation is key in trying to develop a healthy lifestyle.

5.Make sure to get enough sleep. When we don’t get enough sleep, we cannot function to our full potential the next day. Lack of enough sleep can significantly affect your physical and mental energy and functioning. So be disciplined to get the 7 or 8 hours of sleep per night. I remember a friend’s comment once, “there is nothing I value more than my health to allow it to take my sleep’s time.” Your dedication to get enough sleep means you are making your health number one priority. Watch for your sleep hygiene.

6.Take time for daily reflection. Whether it is journalizing, meditation, or prayer, there is scientifically proven benefit of taking time to relax, be still, and evaluate one’s life. Such activities give us a chance to be away from others and listen to our personal feelings, needs, and thoughts. One can always start with 10 or 15 minutes of quiet time and increase the time as much as he/she would like. Such daily self-reflection, meditation, or spirituality can give you clarity and empowerment for your daily tasks as well as your bigger goals that you strive to live for.

7.Feeding our brain with real food. Our technology based era seems to give us tidbits of information giving us a false sense of knowledge and learning. Real reading can enrich our lives by enhancing our understanding and facilitating behavioral change. Often, we rely on others to inform and educate us and we don’t try to check the facts for ourselves. By reading good books on our topics of interest or specific need, we may find our own answers. The learning and knowledge we get by reading can enhance our understanding of ourselves and others, inform us to make good decisions, and help us achieve our goals of improving ourselves.

8.Taking time to laugh and play. Laughter and play with others can be a good stress reliever as well as a way of connecting with others. When your daily schedule is filled with all the mentally draining and physically demanding projects, you need an outlet to relax your body and mind. Laughter is one good practice. But hobbies, social interactions, and other pleasant activities can serve the same purpose.

In summary, these health tips are about recognizing the benefit of the small self-care habits that we tend to neglect. To reach our grand wishes and goals, we have to be strategic in how we live our daily life, and focus to sustain ourselves to remain physically fit and mentally motivated.

The small changes that we make in our daily activities may be the key to achieving our goals this year! But the million dollar question is whether we consider our well-being and personal goals important enough to make the small necessary changes. If not, this may prove to be just another ordinary year.

Posted in Health | 1 Comment

TENAYISTILIGN’S TOP 10 STORIES OF 2013

Posted on December 30, 2013 by Tenayistilign

by Dr Solomon A Feyissa

1. Passing of Nelson Mandela

After suffering from a prolonged respiratory infection, Mandela died on 5 December 2013 at the age of 95. He died at his home in Houghton, Johannesburg, surrounded by his family. His death was announced on television by President Jacob Zuma.

On 6 December 2013, President Zuma announced a national mourning period of ten days, with the main event held at the FNB Stadium in Johannesburg on 10 December 2013. He declared Sunday 8 December 2013 a national day of prayer and reflection. Mandela’s body lay in state from 11–13 December at the Union Buildings in Pretoria and a state funeral was held on 15 December 2013 in Qunu, South Africa. More than 91 world leaders, the largest gathering in the continent’s history, made their way to his memorial.

Mandela died, leaving a legacy that extended far beyond ending 46 years of apartheid in South Africa. He inspired generations around the world to fight not just for racial equality, but for inclusiveness.

2. Political crisis in Egypt: Correction of high jacked revolution or return to authoritarianism.

In 2013 we have seen the removal of Mohamed morsi and Muslim brotherhood from power and the return of military led government.

Almost three years after the overthrow of Hosni Mubarak, some question what has become of the revolution. Some say Egypt has returned to the kind of police state which the revolution aimed to remove. Others point out that it is disappointing to see that Egypt is almost back where it started three years ago. There is growing concern about a return to authoritarianism in Egypt, where the military-installed authorities have cracked down on freedom of speech, stifled protests, and arrested activists. Mohammed Morsi and many thousands of Brotherhood members have been detained. The crackdown on the Brotherhood has been portrayed by officials as a struggle against terrorism. Protests against the new law on public gatherings are continuing despite dozens of arrests. Many Egyptians share the belief that Gen Abdul Fattah al-Sisi averted a civil war.

Next year ( 2014)Egyptians will vote for a new constitution, president and parliament.

3. Conflict in South Sudan

By the end of 2013 the world has witness a political conflict with possible ethnic /tribal dimensions in southern Sudan. More than 1000 people are believed to have died in clashes in South Sudan between rival army factions. President Salva Kiir says it was a coup attempt, blaming soldiers loyal to former Vice-President Riek Machar for the trouble, but Mr Machar denies this. The trigger appears to have been political and escalated into ethnic violence. President Kiir believes there was and has pointed the finger of blame at Mr Machar, who is now in hiding. Mr Machar denies the accusations, but has publicly criticized Mr Kiir in the past for failing to tackle corruption and said in July that he would challenge him for the SPLM’s leadership. Mr Machar also has a troubled history with the SPLM, leading a breakaway faction in the 1990s.

The current conflict has the potential to be a “fully-fledged war throughout the country” between the Dinka and Nuer communities. More than 80,000 people are said to have fled their homes and there are reports of mass killings along ethnic lines. Forces backing Mr Machar had seized the key towns of Bor (now back in government forces) and Bentiu, capital of the oil-producing Unity State.

The country is awash with guns after the decades of conflict and there is a history of tension between rival ethnic groups, which politicians could whip up if they believe that could help them gain, or remain in, power.

4. Syria’s civil war

Fueled by the Arab Spring, Syrian protests have devolved into a brutal civil war with more than 2 million refugees and 120,000 others killed in a country of 21.1 million. The use of sarin, whose prohibition Syria had agreed to in 1993, nearly brought direct U.S. action. Peace talks have been scheduled for January 2014.

5. Philippines Typhoon

Typhoon Haiyan strikes the Philippines on November 8, 2013, killing more than 5,000 people. Haiyan, aka Yolanda, is possibly the strongest recorded storm to make landfall.

6. Edward Snowden NSA leaks

Former NSA contractor Edward Snowden leaks info on the NSA’s mass surveillance program on civilians. He’s charged with espionage and theft, and flees to Russia, where he is given temporary asylum.

7. A new pope

In a shocking move, Pope Benedict XVI becomes the first pope to resign in almost 600 years. A month later, Cardinal Jorge Mario Bergoglio is elected his successor, taking the papal name Pope Francis.

Mario Jorge Bergoglio, a former papal candidate, found himself in the Holy See when Pope Benedict opted for a centuries-first retirement package. His homage to St. Francis of Assisi and humility endeared Pope Francis to millions.

8. Boston Marathon attacks

On Patriots’ Day, April 15, as more than 23,000 runners wended through historic Boston, two brothers allegedly set off a homemade bomb near the finish line, killing three and injuring 264. They picked the wrong city. Within days, police tracked down the Tsarnaev brothers, one of whom died and the other faces trial in 2014.

9. Iran-US warming of ties

For the first time since 1979, President Obama speaks directly to the leader of Iran. Iran later reaches an agreement to limit its nuclear activities in return for lighter sanctions.

10. Rollout of Affordable care act ACA ( Obama care)

Obamacare has been a lightning rod since the president signed the executive order in 2010. The ACA survived a Supreme Court challenge and a presidential election, but it buckled under technical glitches during roll out.
The pre ACA health care financing and coverage leave out about 15 % of the population. Thus ACA tried to address the coverage issue and aimed to make heath insurance reform in order to increase the coverage up to 95 to 100% of the population.
Core Aspects of the ACA: Primarily based on Massachusetts health care reform ( Romney Care)

1. Medicaid ( medical assistance ) expansion by changing the income criteria so that many more millions would be eligible.
2. Mandating employer sponsored insurance for employers with work force of 50 or more.
3. Allowing children to stay on their parents plan/insurance until age of 26.
4. Creating health exchanges as online one stop insurance comparison and shopping site/tool to encourage competition among insurance providers and help individuals get a better choice and deal.
5. Provide subsidies for those who can’t afford insurance so that they will be able to buy one.
6.Individual mandate ( every one should buy insurance or pay penalty) to decrease risk pool by mandating young and healthy people to buy insurance in order to off set the cost for health care of older and sicker people.
7. Individuals will not be discriminated based on age, gender and pre-existing medical condition by insurance companies

　

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Season greetings: remembering the people who made a difference in our lives

It was dark, the beginning of winter. She squeezed my hand anticipating that I would panic looking at what was about to cross us. We were walking to her hut after a dinner in a distant neighbor. We both didn’t know how late it was; no one had a watch.
It was late June, at the end of Ethiopian school year. When I arrived at Yegmar, a small farmer’s village in Gurage country, to spend the winter months with grandma, I was about 11 years old. That was my first road trip by myself. It took about a 6 hours bus trip to get to Wolkite, a modest town, and a ride on an aging and crowded Land Rover for the next few hours to Agena, the closest town with transportation. Grandma had sent two teen age boys to wait for me. It was Saturday, a market day. We bought some salt, cooking oil and coffee beans on our way to Yegmar on foot. After about an hour of walk, I was shocked to find a river with no bridge that we had to cross. The boys saw the fear in me. They kept me in the middle as we navigated the river, the water reaching our waist, the rocks kicking our toes, one hand holding my shoes, the other one of the boys. I imagined what it would be like had it rained. I would later learn that there were accidents with crocodiles. The farmers lined up couple of long trees on the river banks to crawl on to cross the river but a strong wind washed it away leaving everyone to walk through the river keeping the weak and elderly away from the only market in Agena, why she had to send the boys to pick me up.
When we finally arrived, I was visibly tired.

“Yetenbi, Yetenbi, Yetenbi.”
Welcome, welcome, welcome

Grandma and her friends greeted me with open arms.

The village of Yegmar was dotted with handful of huts of mud walls with a wooden pole in the center and a grass roof, the earth floor shined with cow dung. On one side of the hut I slept with grandma on a mattress on the floor; the other side was left for the sheep and the cows with open fire in the center. Grandma was a widow but as strong a farmer as any of the men. She owned the land. She grew potatoes, tomatoes, green peppers, cabbage and ensete, the principal crop of the Gurage.

For those three months in Yegmar, I became a herd-boy. I would take out the sheep and the cows to the field after a warm milk straight from the udder along with a piece of kocho, thick bread made of ensete.
So in that dark winter night, on our way home from a late dinner, a wild animal approached us. I panicked and squeezed her hand. We crouched motionless, holding each other.

“It’s a hyena…come on boy.”

She picked me up and we continued our walk. The animal drifted away in the forest limping. I was drenched in sweat. She hugged me as we closed the door behind our hut. She lit the fire. That was when I saw that tear had swelled up in her eyes.

Grandma, I said, are you not afraid to live here by yourself?

“Boy,it is my land.”

“This is where my ancestors lived.”
“This is the way it has been.”
“This is the way it will be.”

This holiday season I remember grandma. She was my role model. She meant everything to me.

Posted on December 25, 2013 by Tenayistilign | 1 Comment

BUSTED: Myth of benefits of vitamins and supplements

Posted on December 23, 2013 by Tenayistilign

By Solomon Alemu Feyissa,M.D

Use of multivitamin supplements increased among U.S. adults from 30% between 1988 to 1994 to 39% between 2003 to 2006, while overall use of dietary supplements increased from 42% to 53% .Longitudinal and secular trends show a steady increase in multivitamin supplement use and a decline in use of some individual supplements, such as β-carotene and vitamin E. The decline in use of β-carotene and vitamin E supplements followed reports of adverse outcomes in lung cancer and all-cause mortality, respectively. Sales of vitamins and other supplements is huge and continue to grow, reaching $28 billion in annual sales in 2010. Sales of multivitamins specifically rose 2.5% in 2012, to $14.2 billion. Similar trends have been observed in the United Kingdom and in other European countries. However the data on the benefits of Vitamins and supplements goes to the contrary of sales figures and use trends.

Data on benefits and risks

Recently published articles on the subject examine the risk and benefits of  vitamins and supplements. Three articles published on 12/17/2013 issue of Annals of Internal Medicine addressed the role of vitamin and mineral supplements for preventing the occurrence or progression of chronic diseases.

First, Fortmann and colleagues systematically reviewed trial evidence to update the U.S. Preventive Services Task Force recommendation on the efficacy of vitamin supplements for primary prevention in community-dwelling adults with no nutritional deficiencies. After reviewing 3 trials of multivitamin supplements and 24 trials of single or paired vitamins that randomly assigned more than 400 000 participants, the authors concluded that there was no clear evidence of a beneficial effect of supplements on all-cause mortality, cardiovascular disease, or cancer.

Second, Grodstein and coworkers evaluated the efficacy of a daily multivitamin to prevent cognitive decline among 5947 men aged 65 years or older participating in the Physicians’ Health Study II. After 12 years of follow-up, there were no differences between the multivitamin and placebo groups in overall cognitive performance or verbal memory. Adherence to the intervention was high, and the large sample size resulted in precise estimates showing that use of a multivitamin supplement in a well-nourished elderly population did not prevent cognitive decline. Grodstein and coworkers’ findings are compatible with a recent review of 12 fair- to good-quality trials that evaluated dietary supplements, including multivitamins, B vitamins, vitamins E and C, and omega-3 fatty acids, in persons with mild cognitive impairment or mild to moderate dementia. None of the supplements improved cognitive function.

Third, Lamas and associates assessed the potential benefits of a high-dose, 28-component multivitamin supplement in 1708 men and women with a previous myocardial infarction participating in TACT (Trial to Assess Chelation Therapy). After a median follow-up of 4.6 years, there was no significant difference in recurrent cardiovascular events with multivitamins compared with placebo.

Other reviews and guidelines that have appraised the role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms. Evidence involving tens of thousands of people randomly assigned in many clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality and that other antioxidants , folic acid and B vitamins, and multivitamin supplements, have no clear benefit.

Exceptions

The authors have noted that certain vitamins and minerals have proved beneficial in targeted populations. Folic acid, for instance, is widely recommended to pregnant women to prevent birth defects of the brain or spine. Iron sulfate is also helpful for anemia in pregnancy. Multivitamins also have shown benefit in malnourished populations in Africa, Asia and other developing nations.

Recommendations/Implications

The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.

The evidence also has implications for research. Antioxidants, folic acid, and B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified. Vitamin D supplementation, however, is an open area of investigation, particularly in deficient persons. Clinical trials have been equivocal and sometimes contradictory. For example, supplemental vitamin D, which might prevent falls in older persons, reduced the risk for falls in a few trials, had no effect in most trials, and increased falls in 1 trial. Although future studies are needed to clarify the appropriate use of vitamin D supplementation, current widespread use is not based on solid evidence that benefits outweigh harms.

With respect to multivitamins, the studies published in this issue and previous trials indicate no substantial health benefit. This evidence, combined with biological considerations, suggests that any effect, either beneficial or harmful, is probably small. As we learned from voluminous trial data on vitamin E, however, clinical trials are not well-suited to identify very small effects, and future trials of multivitamins for chronic disease prevention in well-nourished populations are likely to be futile.

 

Conclusion

β-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases. Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, the authors believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention.

References:

1. Editorials | 17 December 2013 Annals of internal medicine.  Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Eliseo Guallar, MD, DrPH; Saverio Stranges, MD, PhD; Cynthia Mulrow, MD, MSc, Senior Deputy Editor; Lawrence J. Appel, MD, MPH; and Edgar R. Miller III, MD, PhD

2.Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013; 159:824-34.

3.Grodstein F, O’Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, et al. Long-term multivitamin supplementation and cognitive function in men. A randomized trial. Ann Intern Med. 2013; 159:806-14.

4.Lin JS, O’Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013; 159:601-12.

5.Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, et al, TACT (Trial to Assess Chelation Therapy) Investigators. Oral high-dose multivitamins and minerals after myocardial infarction. A randomized trial. Ann Intern Med. 2013; 159:797-804.

6.Huang HY, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med. 2006; 145:372-85.

7.Bjelakovic G, Nikolova D, Gluud C. Antioxidant supplements to prevent mortality. JAMA. 2013; 310:1178-9.

8.Miller ER 3rd, PastorBarriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005; 142:37-46.

9.Miller ER 3rd, Juraschek S, PastorBarriuso R, Bazzano LA, Appel LJ, Guallar E. Meta-analysis of folic acid supplementation trials on risk of cardiovascular disease and risk interaction with baseline homocysteine levels. Am J Cardiol. 2010; 106:517-27.

10.Gahche J, Bailey R, Burt V, Hughes J, Yetley E, Dwyer J, et al. Dietary supplement use among U.S. adults has increased since NHANES III (1988-1994). NCHS Data Brief. 2011; 1-8.

11.Moyer VA, U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013; 158:691-6.

Posted in Current events, Health | 1 Comment

The challenges of kidney disease in Ethiopia; a call for diaspora involvement

Posted on December 18, 2013 by Tenayistilign

There are only 9 nephrologists in Ethiopia for a total of 90 million people!

Yewondwossen Tadesse Mengistu MD, consultant Nephrologist and Head, Renal Unit , Head, Department of Internal Medicine, School of Medicine
College of Health Sciences, Addis Ababa University
Addis Ababa, Ethiopia

 The birth place of Australopithecus Afarensis (also called Dinkinesh or Lucy), the origin of the Blue Nile, Ethiopia is the second most populous country in Africa, with a population close to 90 million. The obelisk in Axum from the 4th century A.D., a northern city where the Ark of the Covenant is believed to be housed, monolithic rock-cut churches of Lalibela from the 12th century exemplify its ancient civilization and importance. It is a country that produced historical icons like the Queen Sheba, Emperor Menelik II, Emperor Haileselassie and more recently known for its legendary athletes such as  Abebe Bikila, Haile Gebreslassie, and Derartu Tulu, to name a few. As the only independent country, it served as an inspiration for many freedom seekers from Patrice Lumumba to Nelson Mandela.  Ethiopia is also the political capital of Africa where it serves as the seat of the African Union.

With this brief introduction, I would like to discuss the challenges of kidney disease in Ethiopia. There is not much out there about the extent of kidney disease in Ethiopia.  If we look at two known risk factors for chronic kidney disease, diabetes mellitus and hypertension, for example, the available data is very limited, still we gather than the prevalence of hypertension varies from 10-30% in urban areas such as Addis Ababa, Gondar, Jimma to 1.8 to 10% in rural Gondar, Sidamo in the South with semi-urban areas falling in between. For example in one well done study involving 3713 adults in Addis Ababa City, 31.5% of  males and 28.9% of females had hypertension defined as  blood pressure ≥ 140/90 mmHg. The same study found that about 20% of males and 38% of females were overweight. The prevalence of diabetes is also high. In a cross sectional study involving over 2000 patients, the prevalence of diabetes mellitus was 6.5% and 6.6% among men and women respectively. Renal diseases accounted for 1.2-6 % of adult hospital medical admissions in reports from various parts of the country. Diseases of the genitourinary system were 5th in rank among the 10 leading causes of outpatient visits (4.45% of visits) in 2006/7. According to the latest WHO data published in April 2011, kidney disease deaths in Ethiopia reached 12,038 or 1.47% of total deaths.

Among adult patients with Acute Kidney Injury (AKI), septic abortion and falciparum malaria were the leading causes in studies in the 1980’s and 90’s. Among children with AKI in Addis Ababa, post-diarrheal hemolytic uremic syndrome (HUS) was the leading cause. Out of 30 patients with AKI, 23 were diagnosed to have HUS, very high mortality of 46.7%. Unpublished more recent data from Tikur Anbessa Hospital, the main teaching hospital of the AAU Medical School, indicates that chronic glomerulonephritis, diabetes and hypertension are the leading causes of chronic kidney disease. Mean age of patients with end stage kidney disease is much younger than reported from the developed world.

A renal (kidney) unit was opened in the Tikur Anbessa Hospital, Addis Ababa, in 1980 with the assistance of a Cuban team from the Institute of Nephrology in Havana. The unit provides outpatient and inpatient services including dialysis (when available), is involved in under and postgraduate training of doctors and research activities. The first peritoneal dialysis (PD) was done in April 1980 and the first hemodialysis was done in June 1981. The 1st private dialysis unit opened in Addis Ababa in 2001. There are presently 6 private dialysis units in A. Ababa (+ 1 in Adama) with a total of ~ 50 HD machines catering for a total of ~180 patients with end-stage renal failure. Two public hospitals in Ethiopia offer hemodialysis for patients with acute kidney failure. There are no patients on chronic peritoneal dialysis in Ethiopia. No kidney transplant services is available in Ethiopia although there is a growing number of patients with kidney transplants done in centers abroad which is close to 150 patients (most in India) over the last several years. More recently ~10 patients are transplanted annually. Ethiopia was a participant with 2 athletes at the World Transplant Games in Durban, RSA, in June 2013. Causes of end stage kidney disease among the transplant recipients’ are diabetes, hypertension, chronic glomerulonephritis and obstructive uropathy . Major problems are encountered in the provision of immunosuppressive medicines and follow-up.  There are only 9 nephrologists in Ethiopia for a total of 90 million people. There are several Ethiopian nephrologists currently practicing in the US and Europe.

In summary

-An increasing patient load with renal diseases both acute kidney injury (or acute kidney failure) and chronic kidney disease ( CKD) but particularly CKD related to a rapid increase in the risk factors for kidney diseases such as hypertension and diabetes.

-Expansion of services commensurate with the country’s means is urgently needed. Initial emphasis need to focus on detection of risk factors and prevention to be followed by improvement in diagnostic services and programs for detection of kidney disease and slowing the progression of CKD. Renal replacement therapy i.e. dialysis and transplantation need to be introduced on a small scale and be expanded based on resources.

-Very low level of awareness about kidney diseases, their risk factors and the threat these pose to the health of the nation among health professionals, policy makers and the public. EDUCATION particularly tailored to each group is the key.

-Lack of data on kidney diseases for presentation to policy makers, planners; therefore, an urgent need to generate data on the magnitude of renal diseases-both institutions based and community based studies are needed.

– Limited resources available for the health sector in general and for non communicable diseases in particular. Finding resources for education, service expansion and research activities from public and private sources are vital.

-Very few qualified professionals working in the field in Ethiopia. Recruiting and training (and retaining) renal nurses, nephrologists and others is a major challenge.

And finally the involvement of Ethiopian nephrologists or friends of Ethiopia in the diaspora in education, research and patient care would go a long way to alleviate the problem in Ethiopia.

References:

BMC Cardiovascular Disorders 2009,9:39 

Diabetes Metab Syndr.2012 Jan-Mar; 6(1):36-41.

Eth. Med J 2004; 42:17-22

Posted in Health, Opinion | 3 Comments

Menelik II: August 17, 1844 – December 12, 1913

Posted on December 15, 2013 by Tenayistilign

As we mourn the death of Nelson Mandel, Ethiopians, Africans and the rest of the world mourned the death of another black icon 100 years ago, Emperor Menelik II of Ethiopia who died in the early morning hours of December 12, 1913.  

On March1, 1896, Emperor Menelik and Queen Taytu , after mobilizing the Ethiopian people, destroyed  Italian army at the battle of Adwa and achieved a stunning victory over the Italians.  The win at Adwa is regarded by some as an event that may have determined the color of Africa.

1895 (Sep 17th) Menelik calls for total mobilization of Ethiopian forces

     Assemble the army. Beat the drum. God, in his bounty, has struck down my enemies and enlarged my empire and preserved me to this day. I have reigned by the grace of God. As we must all die (sometime), I will not be afflicted if I die…Enemies have come who would ruin our country and change our religion. They have passed beyond the sea that God gave us for our frontier. I, aware that herds were decimated and people were exhausted, didn’t wish to do anything until now. These enemies have advanced, burrowing in to the country as moles. With God’s help, I will get rid of them. Men of my country up to now, I believe I have never wronged you, and you have never caused pain to me. Now-you who are strong, help me…and you who are weak, help with your prayers, while you think of your children, your wife and your faith. If —you refuse to follow me, look out! You will hate me for I shall not fail to punish you. I swear by St Mary that I shall never accept any plea for pardon. Men of Shewa await me at Were Ilu and may you be there by the middle of Tekemt (October 25th)

Some reactions about Ethiopian victory in Adwa:

New York Times March 4, 1896

 “ITALY’S TERRIBLE DEFEAT”

“Three Thousand Men Killed, Sixty Guns and All Provisions Lost.”

“ Baratieri’s Strategy Condemned.  All Available Steamers for Transport of Reinforcements to Abyssinia are ordered. It was rumored today that the latest defeat of the Italians by King Menelik had compelled Ministry to resign.”

“The Pope is greatly disturbed by the news. Among the many reports current today was one to the effect that Gen. Baratieri had committed suicide, being unable to endure the humiliation of his defeat.”

Vanity Fair featured Menilek,1897 : “quite an enlightened monarch”

Menilek was vaulted in to the company of international celebrities as Charles Darwin, Czar Alexander, and Napoleon III

Reaction in France

Liebig’s, a German nutritional form with global reach, featured Taytu and Menelik on individual trading cards

Menilek as a name was given to new borns

The imperial palace in Addis was swamped by fan mails some requesting for money or favors…one fan asked 200 francs to finish her house

Vatican’s reaction

“One of the most important personages, not only in Africa, but in Europe…His friendship is sought by the greatest European powers”

Russians reaction

Russian mission appeared in Addis shortly after the imperial couple returned to their capital. The Russian Red Cross brought free supplies such as tents, sheets, beds, and surgical gear and offered free medical care.

British reaction

Italians were widely perceived in Ethiopia as proxies for British Interests in their own ongoing struggle with France for mastery of Africa.

The Ethiopians were resentful of British complicity in the occupation of Massawa and Eritrea.

 Queen Victoria send a letter with her diplomatic mission ( Sir Rennell Rodd) in the spring of 1897 and was able to clarify Menelik’s position with respect to the Sudan

The American Mission To Menilek

Robert Peet Skinner ( from Massilon, OH) led the American Mission to Menilek

US was interested “in the preservation of the independence of Abyssinia … which will be the only independent state of any consequence in the continent.”

Teddy Roosevelt about Menelik/Ethiopia: … “we must look out for seeds of useful unknown plants” …“ Grevy Zebras could go several days without water. Perhaps, with their help, we could breed a new mule that would be enormously valuable in some of our parched western country”…

Menelik :“America Alone was without land in Africa”

Menelik expressed admiration for Abraham Lincoln and the Emanicipation Proclamation.

Skinner returned with seeds and with Grevy zebras (National Zoo in Washington) and two gift lions (one survived the trip)

African American Reaction

Christian churches serving African Americans added “Abyssinian” and “Ethiopian” to their names such as The Abyssinian Baptist Church of Harlem, the Ethiopian Church of Pretoria.

Reaction in Haiti

Benito Sylvain made the journey to Ethiopian in Jan 1897 to establish diplomatic relations between Haiti and Ethiopia.  He represented both Haiti and Ethiopia at the first-pan African meeting in 1900.

REFERENCES

  • Jonas, R. (2011). The Battle of Adwa: African Victory In The Age of Empire,Cambridge:Harvard University Press
  • McLachlan, S. (2011). Armies of the Adwa Campaign 1896: The Italian Disaster in Ethiopia, Oxford: Osprey Pulishing Ltd.
  •  Prouty, C. (1986). Empress Taytu and Menilek II: Ethiopia 1883-1910, New Jersey:The Red Sea Press.
  •  Marcus, H.G. (2002). A History of Ethiopia: Los Angeles: University of California Press.
Posted in History | Leave a comment

A piece of my day: moonshine (Arake)

Posted on December 12, 2013 by Tenayistilign

Detroit, 2006.

His big toes were swollen , could hardly walk. He knew when his gout flared but he was frustrated because it was happening more frequently than the previous years. He threw the towel and decided to finally seek medical care when he started to have pain and swelling in his elbows and wrists.  He then came away with two more diagnosis, hypertension and kidney disease.

So there he was sitting in front of me with his wife and a bunch of papers, some receipts of recently purchased medications and labs that showed kidney failure and high uric acid.

I reviewed them quickly.

What brought you here?

“They called me to come see you; for kidney or something,” he said hesitantly.

“And my blood pressure,” he added.

So you have gout?

“It is bad,” he said, showing his swollen elbows, wrists and toes.

What do you take for the pain?

“Nothing works. I tried Tylenol, Aleve.”

He looked at his wife.

“Just tell him,” she said.

“I drink a little something for the pain.”

The triad of gout, hypertension and kidney disease was enough for me to cut the chase.

Do you drink moonshine?

When I saw a bit of a surprise on their faces followed by loud laughters, I knew I was in to something.

“Once in a while, it is hard to get it around here,” he said, lowering his voice.

“That is the only thing that takes away his pain but the gout keeps coming,” she added.

Moonshine is an alcoholic beverage often brewed illegally in many parts of the world. In Africa it takes the lion’s share of the alcoholic industry. It has different names in different parts of the world. In Kenya for example it is called “Kumi Kumi” or “kill me quick”. It is widely brewed throughout Ethiopia and known in many places as Arake. I remember grandma allowing us a sip when we had stomach ache…a belief that it killed germs. I remember retirees in the neighborhoods killing some time and the stress off over cups of Arake, some with canes nursing swollen joints.

Moonshine is hazardous. It can be contaminated with metals such as lead, particularly if radiators are used as condensers. It can also be contaminated with toxic alcohols such as methanol. When lead is consumed even in small quantities, it competes with uric acid for elimination through the kidneys leading to elevated levels of uric acid in the blood. High uric acid is a risk for gout. High uric acid has also been associated with elevated blood pressure and chronic kidney disease.

Reluctant at first but a urine test of high lead levels convinced him to dump a large quantity of moonshine that he purchased in the blackmarket and stashed in his bedroom.

Over the next 6 months we were delighted to see a simple intervention making a big impact; his uric acid levels decreased, the joint pain and swellings markedly improved, his blood pressure was easily controlled and his kidney function stabilized.

Posted in Memoir | 2 Comments