PSoTD

Another rather scary step in the progression of avian flu, as reported by Effect Measure:

WHO is now saying what could be inferred from their update yesterday: it is likely that for the first time H5N1 has spread from human to human to human -- three generations of cases, possibly four. This does not mean that a pandemic strain has started but it is another warning signal.

If we take the statement that there has been no change in the virus (let's see the sequences!), then there is another inference we might make. This is just the first time WHO has acknowledged this, not the first time it has happened. Since many cases in Vietnam, China and elsewhere lack solid evidence of close contact with poultry this may have happened many times over (see our post here). The index case here was a vegetable seller in a market where there were live animals, so she wasn't in contact with poultry as an occupation. She might well have contracted the disease from sick poultry at the market but she might also have contracted it from someone else at the market (or elsewhere).

As a result of this cogent evidence in Indonesia, WHO may convene a standing committee of experts to decide if the pandemic alert level should move from the current Phase 3 to a new Phase 4.

WHO weighed in last week...

THE World Health Organisation is concerned over the migration and recruitment of health workers from Africa, an official has said.

In a speech read on her behalf on Friday to mark the International Nurses Day, WHO country representative for Namibia, Dr Custodia Mandhlate said the recruitment of health personnel from African countries by developed countries undermined investment in the health delivery system.

"We need to ensure that this free movement of professional health workers does not undercut national plans to improve human resource supply and distribution. This is a critical element in our endeavour to strengthen our health systems and provide quality service," she said.

Dr Mandhlate added that WHO was concerned that inadequate staffing in health institutions was reaching crisis levels in all regions, leading to an increase in the length of hospital stays, patient complications and mortality and preventable adverse situations.

Noted Dr Mandhlate: "Health workers, who also include nurses, provide health care to those who need it. But around the world, the health workforce is in a crisis - a crisis to which no country is entirely immune. Health care environments vary worldwide, but the need for adequate staff is shared. This goes beyond the minimum required for potential substandard care."

She urged health care workers and associations to determine safe staffing levels in the context of patient requirements, collect relevant clinical and workforce data, disseminate and demonstrate the importance of safe staffing, form alliances to support safe staffing policies, undertake impact assessment studies and prepare a communication plan that effectively influences decisionmaking.

Solutions to the crisis must be worked out at local, national and international levels and involve governments, the United Nations, health professionals, nongovernmental organisations and community leaders, she said.

Most African countries have been hit by an exodus of health professionals mostly to Europe. A number of Zimbabwean nurses and doctors have left the country for Britain, Australia and some have recently tracked to Swaziland. Namibia also faces the same problem and entered into agreements with governments of Cuba to provide doctors and Kenya to provide nurses. Zimbabwe Health Minister Dr David Parirenyatwa announced at the weekend that the Southern Africa Development Community was taking steps to minimise poaching of doctors and nurses by requiring the country of origin of a health professional to agree to his or her employment in another SADC state. Under a protocol, no SADC member state shall disadvantage another by luring or "stealing" health professionals using economic superiority.

Okay, it's not really new, but maybe something you haven't thought of, particularly in the light of Avian flu... The western nations are taking their health professionals away. From Kenya's Daily Nation:

In a span of four years, 3,390 of Kenya's 30,000 registered nurses migrated to Europe and the United States. During this period between 2000 and 2004, about 1,200 nurses were leaving Kenya for greener pastures every year, the National Nurses Association of Kenya (NMAK) says.

This was not necessarily a bad thing, Mr Simba K’odambo, the NMAK chairman, said as they marked the Nurses Week in Nairobi last Friday.

Nurses have long been overworked and underpaid and found themselves ripe for easy pickings with the attractive pay offered by clinics in countries that have so willingly absorbed them.