Healthcare in Afghanistan: ‘doctors are threatened at gunpoint, even by civilians’

It’s dangerous to be a doctor in Afghanistan.

This is what the staff deal with most days at a hospital in the country’s north-west: physical attacks by patients’ relatives; gun-wielding soldiers inside the wards; and verbal assaults and threats of bodily harm against doctors and nurses who are only trying to help.

An Afghan surgeon I’ve met keeps a gun at home for protection, and I understand why.

Assailants recently attacked two female nurses, causing cervical spine injuries. Another nurse responding to a mass casualty event arrived at the hospital to be assaulted and choked by relatives of a wounded patient who were demanding immediate service.

Why does this kind of violence happen in hospitals in conflict zones? There is no easy answer to that question. A patient, relative or combatant could be in pain, confused and stressed, in a life or death situation and an unfamiliar environment. They may well be angry, armed or suspicious about our neutrality. They’re living in a community consumed by conflict. But that does not mean violence, of any kind, against medical professionals is acceptable.

Doctors and nurses, ambulance drivers and paramedics, hospitals and health centres have all come under attack in Afghanistan. This disrupts the delivery of medical care when people need it most. Patients – both civilians and combatants – die because they are prevented from receiving needed care. The disruption can be so severe that the entire system collapses.

‘No weapons’ signs are routinely ignored at the hospital entrance

“No weapons” signs are routinely ignored at the hospital entrance in Maimana, capital of Faryab province. Recently I watched two soldiers, M16 rifles dangling over their shoulders, standing guard over a wounded comrade. When I asked the staff why we didn’t disarm them, I was told they were protecting their fellow soldier.

Staff don’t dare tell the soldiers to leave their arms outside and you can understand why. When a military commander was shot dead inside the hospital by opposition fighters two years ago, the doctor on duty was the one arrested, although he was later released. Arms carriers have since become even more reluctant to yield their guns before entering the hospital.

The hospital security guards once tried to disarm men entering the grounds with guns and were beaten. When a hospital administrator tried to take away weapons from a security official, the official threatened to kill the administrator. He later apologised but the deed was done.

I have witnessed these violations while working on an International Committee of the Red Cross surgical team. We are carrying out short missions to some of Afghanistan’s most important hospitals to assist the medical teams and help them learn more advanced techniques.

The Maimana hospital is fairly well equipped, and has four skilled surgeons and good hygiene standards. That’s better than many Afghan hospitals. But police officers, soldiers and even civilians there routinely threaten doctors and nurses to compel them to provide priority care at the point of a gun.

Even health workers’ families are not safe. A surgeon’s child was briefly kidnapped just a month ago. Another doctor’s child was kidnapped a few months earlier, forcing the doctor to sell his home to pay the ransom. One surgeon and his family were so afraid of the recurrent threats that they simply packed their bags and left.

This all leads down a dangerous, deadly path.

My message to community leaders, fighters and even average citizens is clear. It is the same message that my colleagues are using in conflict zones across the world: if you don’t respect and protect the healthcare workers, you will soon find no one left to care for you.

Wars must have limits, so respect the laws of war. Respect hospitals and the staff working in them. Let them do their jobs.

Neill Kling is a surgeon with the International Committee of the Red Cross’s mobile surgical team in Afghanistan

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Healthcare in Afghanistan: ‘doctors are threatened at gunpoint, even by civilians’

Antibiotic resistance in farm animals "threatened by United kingdom cuts"

Government cuts could influence the UK’s potential to detect antibiotic resistance in farm animals, senior veterinary authorities have warned.

The advancement of germs that are resistant to even the strongest of our recent antibiotics is one of the most significant health threats in the globe, in accordance to the government’s chief public health official, Professor Dame Sally Davies.

Last month the Planet Health Organisation explained above-use of antibiotics had meant they had misplaced their effectiveness at fighting infections in each and every country in the globe. Antiobiotic resistance among animals is a separate but associated issue, and can have repercussions for human wellness.

Professor Peter Silley, of the University of Bradford, said: “Surveillance [of antibiotic resistance in animals by normal testing on farms and in depth lab perform] is expensive to do properly – really costly. But if you search at surveillance now it is significantly much less than it was ten many years ago – I believe most of that is budgetary.”

He added: “If surveillance is not mandatory, that is a difficulty. It is costly and will not happen. Then we will struggle. We need to fund this science correctly. My concern is that we are not going to be ready to do that.”

The Division of Environment, Meals and Rural Affairs, which has obligation for agriculture and animal health, has accepted some of the steepest cuts of any Whitehall department. Defra had not responded at the time of publication.

John Fitzgerald, secretary basic of the Accountable Use of Medicines in Agriculture Alliance, said: “With the Defra cuts, ministers have to pick what it is most essential to invest on. The question of antibiotic use should be one of their top ten risk assessments. I hope that the government cuts would not have an effect on this – it must be given income – but we really don’t know.”

Scientists at a briefing held by the Science Media Centre in London also warned that no move to curb antibiotic use in humans – this kind of as the proposal by Davies for a United Nations convention to manage antibiotic use – ought to be taken without having related focus to the use of the medicines in animals.

Even though animal diseases are different to these of people, and the vets mentioned there was tiny evidence that growing resistance in animals was a main threat to human wellness in the Uk, they stated that in some areas of the world antibiotic use is largely unregulated, or laws go unenforced, and that this was a serious concern.

Professor Stuart Reid, principal of the Royal Veterinary University, said: “In the absence of great worldwide controls, there are places of the planet that have significantly less management, and this is a actual concern. There are substantial gaps we have to function on collectively.”

Fitzgerald said: “If there is going to be a UN [treaty], we should include animal health, as there will otherwise be no point to it.”

Outbreaks of ailment in animals that have affected people contain salmonella and campylobacter, which result in meals poisoning.

But the vet said that the controversial rise of “megafarms” – in which hundreds of cattle, chickens or pigs are kept in huge warehouses – was good for cutting down on animal ailment, in spite of worries that trying to keep so a lot of animals in 1 location could intensify any outbreak.

Fitzgerald said: “Megafarms are not utilizing far more [antibiotics] per animal. They are bigger but significantly a lot more hygienic [than other farms], they are greater managed, and substantially greater created to make certain of optimum problems to avoid condition.”

He explained the conditions had been carefully managed to stay away from ailment outbreaks, and their owners had a vested interest in keeping their “biosecurity” tight, since it would demonstrate so pricey if drugs had to be utilized.

In Europe, employing antibiotics in a schedule way – no matter whether animals are sick or not, to encourage the beasts to expand faster – has been outlawed considering that 2006. The vets stated it was unlikely that this regulation was becoming flouted in the Uk, due to the fact of the cost of the medication and the oversight of veterinary experts.

Worries have also been raised about the widespread use of antibiotics in fish farming, but in the Uk their use amongst fish has come down in recent many years, according to Prof Silley.

However, these practices are nonetheless widespread in other nations, like the US and South America.

Prof Reid explained: “In the US, there are issues [because of] the use of growth promotion is even now permitted. What transpires elsewhere [in some countries] is a entirely unregulated surroundings.”

He extra: “Sometimes I’m disappointed that there is not a holistic view currently being taken.”

Antibiotic resistance in farm animals "threatened by United kingdom cuts"

New Medtronic Heart Valve Threatened By Court Selection

A legal injunction might severely limit the availability in the United States of Medtronic’s CoreValve gadget, which only acquired FDA approval earlier this 12 months. The device acquired abundant praise not too long ago when a massive clinical trial demonstrated significant advantages for CoreValve more than conventional open-heart surgery.

The injunction is the newest episode in an ongoing patent war in which Edwards Lifesciences, which pioneered the field of transcatheter aortic valve replacement with its Sapien gadgets, has sought to hinder Medtronic from competing in the US and global markets. This specific situation was initiated in 2008. In 2010 a federal jury’ made a decision that Medtronic had infringed Edwards’ Andersen transcatheter aortic valve substitute patent. The decision was affirmed by the Court of Appeals. The Supreme Court declined to evaluation the case.

Even though the judge accepted Medtronic’s contention that CoreValve has essential clinical advantages he ultimately sided with Edwards. Right here is the important passage in the judge’s oral determination on Friday.

Regarding the public interest aspect, the Court is persuaded that there are sufferers who can’t be served by either the Sapien or Sapien XT and who need the CoreValve Generation three. The Court is also convinced that the CoreValve Generation 3 is a safer device and that patients in whom it is implanted have far better outcomes with a lower risk of death. At the identical time, the Court are not able to downplay the robust public curiosity favoring enforcement of patent rights. Therefore, the Court finds that the public interest weighs in favor of granting Edwards a preliminary injunction, but that Medtronic need to be allowed to promote its devices to individuals patients who can’t be helped by Edwards’devices.

The judge ordered the two businesses to negotiate an arrangement so that CoreValve could proceed to be used in US centers at the moment trained on CoreValve. The judge also agreed to postpone implementation of the injunction for one particular week in order to enable Medtronic a possibility to appeal the injunction. (On Monday, according to Fierce Medical Units, Medtronic filed its motion to postpone the injunction and appeal the ruling.)

Wells Fargo analyst Larry Biegelsen estimated that if the injunction is upheld CoreValve will be constrained to about 15% of the US marketplace till patent expiration in March 2016.

The Wall Street Journal interviewed John Carroll, the director of interventional cardiology at the University of Colorado Hospital, which uses the Sapien valve but had planned to start off coaching to use the CoreValve as nicely. Carroll told the WSJ that Medtronic had put the coaching system on hold. ”It’s a shock because the gadget has been accepted and is getting employed commercially,” explained Carroll.

I asked David Kandzari, the director of worldwide cardiology at the Piedmont Heart Institute, for some extra viewpoint. He mentioned that there are further patent situations that could threaten CoreValve.  ”In brief, the story is not over, even after this story is more than,” he stated.

Referring to the historical precedent of drug-eluting stents, Kandzari suggested the two companies may in the end attain a financial arrangement which would allow CoreValve a substantial presence on the market. Edwards, he recommended, could injury itself by looking for excessive limitations on CoreValve availability:

As a lot as this is unfavorable for Medtronic, it also represents a public relations dilemma for Edwards. In other words, do they seem to be suppressing a worthwhile technology for their personal self interest, or alternatively, do they present goodwill with some agreement for CoreValve to remain on the US market place?

New Medtronic Heart Valve Threatened By Court Selection

Whistleblower threatened with sack more than hospital death fee worries

It warns the hearing, “may outcome in formal disciplinary action, not excluding dismissal.”

The trust rejected the allegations of altering the death prices, calling them an “outrageous slur”, and mentioned independently-verified proof “categorically disproved” her claims.

Its chief executive, David Loughton, said at the time: “Improvements in the hospital’s mortality costs have been audited and independently verified.”

Mrs Haynes-Kirkbright was suspended by the believe in after allegations of bullying, harassment, persistent swearing and unprofessional behaviour have been created towards her by colleagues by means of their union in April 2012.

She claims situations at the hospital had been as negative or worse than at scandal-hit Stafford, and that the allegations and suspension were created in an try to silence her.

She stated: “I come to feel like David fighting Goliath. I’ve just been telling the truth.”

Her case comes following Jeremy Hunt, the Health Secretary, referred to as for a “culture of openness and transparency” following the Stafford Hospital scandal.

Mrs Haynes-Kirkbright, initially from Texas, worked as a health coder at Wolverhampton, which involves recording particulars of the care obtained. The role does not require medical qualifications.

She claims coders have been recording too many deaths beneath palliative care, which are deaths classed as unavoidable and would consequently not alter a trust’s death prices record.

Mr Loughton said: “We categorically deny all the allegations and have provided thorough evidence to the Everyday Mail to assistance our place that the suggestion of any incorrect-undertaking is merely not accurate.”

Whistleblower threatened with sack more than hospital death fee worries