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"The greatest crime against humanity of this century"

September 11, 2005 -- In a lengthy comment in today's Observer (U.K.), Jonathan Dimbleby urges world leaders not to squander the chance to "end poverty" by "bickering" during the United Nations summit this week in New York. Dimbleby is a major U.K. news media figure and president of the charity Voluntary Service Overseas (VSO). He illustrates his argument for releasing aid to Africa with a discussion of his recent visit to Malawi, whose 12 million impoverished people receive care from a grand total of 94 Malawian physicians and 300 Malawian nurses. By comparison Sweden, with a population of 9 million, has about 90,000 practicing nurses--that is, 400 times as many nurses per person for a far healthier population.

Dimbleby begins by arguing that it would be an "abdication of political and moral responsibility" for the world's powerful nations to become so distracted by the "war on terror" or the U.N.'s "oil for food" scandal that they effectively abandon the vital Millennium Development Goals agreed to several years ago. Admitting that these issues are "complex and immensely problematic," he urges rich nations to honor and expand their commitments to debt relief, fair trade, and material and technical aid. He asserts that if they do not, they will be "open to the charge that they are complicit--by neglect--in the greatest crime against humanity of this century." Seeking to show isolated world leaders the "devastating effect of global poverty," he turns to Malawi, which he describes as a peaceful, "open society not unduly plagued by corruption," despite being one of the ten poorest nations in the world.

Dimbleby paints a grim picture of Malawian health, which the Minister of Health himself terms "a catastrophe." Perhaps 20% of the population is HIV positive, maternal mortality is the highest in the world (and rising), and life expectancy has fallen to 37 years. Dimbleby describes a district hospital two hours from the capital as "the medical equivalent of a warfront." There is one local physician and one Dutch VSO physician; the nurse:patient ratio is 1:60. The hospital's equipment is in disrepair and it has run out of "almost every essential drug." It has nothing to treat malaria, the nation's "biggest killer." In one ward, an 18-year-old with meningitis "died slowly and in pain." Despite all this, some key donors believe the Ministry of Health has a plausible plan "to confront Malawi's predicament: to arrest the haemorrhage of doctors and nurses from an underfunded and demoralised service either to other parts of Africa, the US and, especially, Britain or into marginally better paid jobs in the private sector." The U.K. and the VSO have provided a team of 30 nurses and physicians to support the care system that remains and "recruit, train and retain more staff." But despite that emergency effort, he says, donor nations have yet to deliver the funds needed to really rebuild the system. Cognizant of corruption, especially in the distribution of drugs, Dimbleby does not recommend simply handing over huge amounts of cash. But he does argue that those holding the funds not delay releasing them on the basis of unduly stringent reform requirements, as he seems to suggest is occurring with the first "trickle" of anti-retroviral drugs given in a fledgling program that seems to be working well--despite concerns that poor nations could not handle such drug regimens.

Throughout this discussion, Dimbleby appears to treat nurses as of more or less equal importance to physicians in the struggle to improve Malawian health (but he does name two local physicians, including the Minister of Health, and no nurses). He also recognizes the critical importance of addressing the staffing shortage of nurses and physicians in such nations, noting that many qualified local staff have left for opportunities elsewhere, especially the developed world. Of course, this is an especially tragic example of the interconnected nature of the global nursing shortage.

We thank Jonathan Dimbleby and the Observer for the piece. We urge everyone to contact their government representatives to ask that that the Millennium goals be funded. Thank you.

See the op-ed "Our last chance" by Jonathan Dimbleby in the September 11, 2005 Observer.

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