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Website: http://www.fiamc.org AFRICA   Delegate to FIAMC Associations Jubilee of the Sick Persons and Health Care Workers (Rome, 8-11 February 2000) DELEGATE TO FIAMC Dr John B. Wilson (Ghana) ASSOCIATIONS Nous venons d'apprendre qu'une association africaine utilisait du papier à en-tête de la FIAMC pour demander des aides financières. Attention, il s'agit de FAUX. Nous informons notamment que la FIAMC n'a pas de "Bureau régional pour l'Afrique de l'Ouest". We've just learnt that an African Association used FIAMC headed writing paper to ask for financial help. Beware ! it is FALSE DOCUMENTS ! We notably inform that FIAMC has NO "Regional Office for West Africa". ANGOLA Associação dos Medicos Catolicos de Angola (AMECA), Conferencia Episcopale de Angola E S. Tome, Rua Cte. Bula 188 - C.P. 3579 - Luanda (Tel/Fax: 244-2-343093) BENIN POP. REP . Association Nationale des Médecins, Pharmaciens et Chirurgiens Dentistes Catholiques de la République Populaire du Bénin, A.NA.ME.P.CA.B., B.P. 08-0016, Cotonou IVORY COAST Association au Service de la Vie, P.O.Box 08, B.P.948, Abidjan 08 (Tel: +225 424 695; Fax: 426 472) GHANA Catholic Doctor's Guild Of Ghana, Rabito Clinic, P.O. Box 18077, Accra (Tel: +233 21 665 401, 666 987, 666 988; Fax: +233 21 668 425; ob-gynae@africaonline.com.gh ) KENYA Dr. A. Kiura, P.O. Box 18077, Nairobi NIGERIA RWANDA Association Rwandaise des Médecins Catholiques, ARMC, Hôpital Universitaire, BP 30 Butare TANZANIA Tanzania Catholic Doctor's Association, TEC Medical Department, P.O. Box 2133, Dar-Es Salam JUBILEE OF THE SICK PERSONS AND HEALTH CARE WORKERS Rome, 8-11th February 2000 CATHOLIC DOCTORS'CHALLENGES FOR THE NEW MILLENNIUM IN AFRICA Dr John B. Wilson, Ghana The doctor working in Africa faces different problems from those of his counterparts in Europe and America. The health of our people in Africa has been influenced by factors, many of which have been eradicated in the developed world. The continent is still plagued by infections and infestations: malaria still takes a heavy toll of lives of especially children under five every year; the six childhood diseases, which have been eliminated by vaccination, are still with us. At the start of the third millennium the doctor in Africa is still without much of the technology that he learns while in training in the developed world or through the journals (the latter may not be too much of a disadvantage if more of the very basic needs were available). The continent faces a major problem with HlV / AIDS which is almost becoming an epidemic. In some countries the positivity rate is over 50% in the people of the reproductive age range. This group happens to be the work force and the future of our countries. Productivity will gradually fall as this group is reduced. At present for the continent, developing HlV / AIDS is equal to a slow painful death since there is no cure for the disease and many of our countries cannot afford the drugs that are available to control the symptoms and prolong the life of the patient. Babies are being born with the disease, and many children are being orphaned because one or both parents have died of the disease. AIDS is even becoming one of the leading conditions associated with maternal deaths in some countries. AIDS can properly be prevented or numbers reduced if sex was limited to couples. However messages being given to the public offer the use of condoms as effective protection against AIDS and other STD's. The propaganda is so strong that it drowns our message of sex within marriage and the fidelity of the couple to each other. Thus AIDS is a major issue which is defying control. With the high numbers of HIV / AIDS is an increase in the cases of T.B. Maternity mortality and morbidity continue to be very high on the continent and may be as high as 2000 per 100 000 live births. When the safe motherhood initiative was launched in 1987, the aim was to reduce maternal mortality by 50% by the year 2000; at the turn of the century, the levels are even higher. A combination of medical, economic and socio-cultural factors combine to maintain this high level. Recently some measures have been developed which are low cost and effective in improving maternal outcome in our countries; these are gradually being disseminated in many countries and so it is hoped that an impact will be made in the area. One may wonder why this situation persists in the developing countries and is even getting worse. The plight of our people is linked directly to the two-pronged "maladies" - poverty and ignorance. These two factors have combined to make good health a prerogative of only a section of the population in many of our countries. Nearly all the African countries are poor even though they produce a lot of raw materials such as gold, diamond, timber, cocoa, oil, etc. A combination of factors such as low commodity prices, proper prioritisation of national needs, rampant corruption, and lack of good governance have succeeded in making our countries poor. Our countries are collapsing under the weight of their external debt and it is our hope that the plea of the Holy Father for the "North" to write off the debts of the developing countries will be heard. Poverty of the individual makes it difficult for him to make use of the health facilities that are available. Many patients are unable to purchase drugs which are prescribed for them; in many countries the adoption of the "Cash and Carry" system delays the onset of treatment even of patients on admission. Sometimes patients have to travel long distances on rugged roads before arriving at a health facility; the problem is often compounded by non-availability of transport or the "high cost" of fares. Health facilities - hospitals, health centres, and health posts are relatively few and may be separated by long distance. In some instances, health facilities are sited based on political expediency rather than on population needs. Thus the poor on the continent, especially the rural folks, have fewer health facilities at their disposal and services can be obtained only at a price that is not affordable. The other malady, which poses a challenge to the doctor in Africa, is ignorance. Formal education is very low in many of our countries and so people do not make use of the health services available early or not at all. Many people still stick to belief and practices that are harmful to health or that prevent them from going to seek modern medical help. As a result of poverty, Government cannot provide enough hospitals and all the equipment and essential drugs. It also pays very low salaries to its workers. This has led to many well qualified doctors leaving developing countries to the developed world to seek greener pastures. Others remain in the country and try to supplement their incomes in other ways such as doing additional jobs, demanding extra fees from patients or indulging in various practices to supplement their incomes. Thus our countries gradually lose some of their best-trained personnel (because most developed countries will accept only specialist) or the patients are denied treatment because they cannot pay. All doctors face these challenges, but the catholic doctor has to be guided not only by the ethics of the profession but those dictated by Church as well. One has to consider whether it is morally right to leave ones country in pursuit of personal gains at the expense of the population whose taxes financed his education or charge patients extra before giving them the needed treatment. There are agencies that offer generous allowance to health personnel to participate in procedures such as contraception, sterilisation and abortion. These are being pushed extensively in Africa in order to reduce the "high population" growth rate. These procedures go against the moral teaching of the church and therefore the catholic Doctor cannot in conscience participate in them. The lure of easy income to a poorly paid doctor in countries where the cost of living is very high poses a big dilemma to the Catholic Doctor practising in Africa. There are only a few of the challenges the Catholic doctor faces. Unfortunately there are very few catholic doctors Guilds in Africa and even these are not very active. Our effort are often thwarted by apathy and the sheer instinct to survive. I see a need for us to form guilds in our countries and eventually have a Regional grouping. Africa is the only continent without Regional Federation. As a Guild, we can support our Bishops conferences that contribute a lot to health care especially in the rural areas. Through the Guild the doctor can be strengthened spiritually and learn much of the church's ethics teaching on medical issues. We will then be able to speak out on issues that are contrary to moral teaching and support our bishops'conferences in providing health care in our countries. I hope that we can count on the support of the other well established guilds.