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Spreading new hope with new limbs in South Sudan

Approximately 60 percent of the patients who come to the Juba centre have gunshot-related injuries and disabilities

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Stephen, 12, romps confidently around the sunlit courtyard, weaving in between wheelchair-bound patients as he plays with the other children, his prosthetic leg barely a hindrance.

When he was five years old, the car he and his family were travelling in hit a landmine in South Sudan’s northern town of Bentiu. His grandmother was killed. His left leg was shattered and had to be amputated.

Stephen was flown to a physical rehabilitation centre run by the International Committee of the Red Cross (ICRC) in Juba, which serves both as a prosthetics factory and a hospital for patients coming from all around the country to be fitted with new limbs.

“It helped me to go to school,” Stephen says shyly, pointing to his artificial leg.

After receiving his first prosthesis in 2013, war prevented Stephen from being able to return for new fittings every six months as recommended. 

When he finally made it to the centre this month, his prosthesis was far too short.

South Sudan’s five-year-long civil war has left possibly tens of thousands of people without limbs — a toll that may never be accurately established.

Approximately 60 percent of the patients who come to the Juba centre – one of three in the country – have gunshot-related injuries and disabilities, according to the ICRC.

But much of the country faces limited access to healthcare, a result of fighting or simply a lack of infrastructure, with roads typically being utterly impassable during the rainy season. 

Many limbs are amputated for no other reason than lack of treatment.

“A simple injury or fracture that could be treated easily in most countries… can result in infections here which result in an amputation because of problems with healthcare,” said ICRC prosthetic specialist Regis Tiffeneau.

“The large majority of patients are affected by the war in one way or the other.”

Others became disabled by polio, rickets – linked to malnutrition – or other diseases that have been eliminated in so many other parts of the world.

Lack of access

In the factory, plaster is slapped on models of legs whirring on machines as workers shape them and then slather them in dark brown plastic.

Workshop manager Emmanuel Loubari said that the prosthesis can be made within a day of a patient being measured and a cast taken. Last year the centre made 580 prosthetic limbs, with the cost of all treatment borne by the ICRC.

But many challenges face patients who need to get fittings.

“We have a lot of patients who are supposed to be fitted, but they cannot have access to the centre,” Loubari said.

In South Sudan, roads are so bad that the ICRC relies on a fleet of planes and helicopters to bring patients to hospitals and the physical rehabilitation centres.

In the rainy season, it can be hard to land in many remote locations.

Bringing people from across the country, injured in fighting mostly of an ethnic nature, brings its own problems.

“They come here, they are traumatised, most of them are injured by gunshots and mines,” said social worker James Soma. “We talk to them about forgiveness.”

He said an argument had broken out the previous day in which one patient accused another of targeting her because of her tribe, and said she would “bring one of my relatives and shoot you all.”

Toddlers shot on mothers’ backs

For those who have used a prosthesis before, like Stephen, it takes only two or three days before they are ready to go home. But for new patients it can take a few weeks.

Other patients at the centre currently include a young man with severe scoliosis — a curved spine — who was being taken to school in a wheelbarrow until he was brought in to get a customised wheelchair.

Another was bitten by a snake and was not treated for almost two weeks, so his leg had to be amputated.

“We have a lot of children coming in,” said physiotherapist Oketta Robert Kanyara. “We have five children in the centre, shot in different styles… We have children shot while tied to their mothers’ backs.”

Five-year-old Laytol was probably bitten by a snake. Her mother comes from the Murle people, and the doctors have difficulty understanding the language. But they believe her leg “could probably have been saved” if she had got help in time.

Laytol, 5, learns how to walk with the use of a new prosthetic limb at the physical rehabilitation centre run by the International Committee of the Red Cross (ICRC) in Juba, South Sudan. (Photo by SIMON MAINA / AFP)

Laytol is trying out her new leg for the first time, balancing herself calmly between two metal bars.

Kanyara, the physiotherapist, said training children requires using games, as they do not understand the idea of shifting their weight and struggle to follow instructions.

But progress can be made. When the physiotherapist started work with Stephen, the boy who lost his leg in a landmine in 2013, the challenges were many.

“It was very, very difficult,” Kanyara said. “You tell him to do weight bearing, but he starts crying, so you have to go slowly.”

Little Laytol took to her new leg more quickly.

“She is very good,” Kanyara said. “She is fitted today, and she is not crying. She is walking.”

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Ex-health minister arrested for embezzling Ebola funds in DR Congo

Ilunga, who resigned as health minister in July, was detained while hiding in an apartment in Kinshasa

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DR Congo's health minister resigns after removal from key Ebola response role
Former DR Congo health minister Oly Ilunga. (AFP)

Former DR Congo health minister Oly Ilunga has been arrested over allegations he embezzled public funds to tackle the Ebola epidemic, police said on Saturday.

Ilunga, who resigned as health minister in July after being removed as head of the country’s Ebola response team, was detained while hiding in an apartment in the capital Kinshasa ahead of a bid to flee the country, officers said.

He is in custody due to “misdemeanors of the mismanagement of funds allocated to the Ebola response,” police spokesman Colonel Pierrot-Rombaut Mwanamputu told AFP.

Ilunga will be referred to prosecutors on Monday, he added.

It comes after Ilunga was questioned in August as part of an inquiry into the management of funds to fight the outbreak, which has claimed more than 2,000 lives since August 2018.

Ilunga, 59, had already been banned from leaving the country.

He stepped down after criticising plans by the UN’s World Health Organization (WHO) to introduce a new, unlicensed vaccine to fight the epidemic.

His lawyer told AFP in September that some payments had been made to local chiefs after the killing of a WHO doctor in April.

More than 200,000 people have been vaccinated during DR Congo’s tenth and most serious Ebola epidemic.

It is the second-worst Ebola outbreak in history after more than 11,000 people were killed in Guinea, Sierra Leone and Liberia between 2014 and 2016.

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Telemedicine revolution saving lives in Ivory Coast

The fledgling technology has long been championed by health advocates for rural economies.

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Telemedicine revolution in saving lives in Ivory Coast

Every time Catherine Coulibaly’s 19-year-old son had to make a routine appointment with the cardiologist for his heart condition, she gritted her teeth as she silently counted the financial cost.

It wasn’t just the hospital fee — there was the transport, food and accommodation, too, all of it amounting to a hefty burden for an Ivorian family on a modest income.

But thanks to telemedicine – consultations that doctors conduct through the internet or by phone – this cost is now a fading memory. 

Her son can book an appointment at a telemedicine facility in a nearby town in northern Ivory Coast.

There, he is attached to monitoring machines which send the data sent to Bouake University Hospital in the centre of the country, where it is scrutinised by a heart doctor.

The fledgling technology has long been championed by health advocates for rural economies.

Ivory Coast has become an African testbed for it, thanks to a project linking the Bouake hospital’s cardiac department with health centres in several northern towns, some of which are a four-hour drive away. 

Telemedicine “caused a sigh of relief for the population of Bouake, Boundiali, Korhogo, everyone,” says Auguste Dosso, president of the “Little Heart” association, which helps families with cardiac health issues.

Some 45 percent of the Ivorian population live below the poverty line, according to the World Bank’s latest estimate in 2017. And the minimum monthly wage — not always respected — is only around $100, or 90 euros. 

Heart disease surging

The pioneer behind the scheme is cardiologist Florent Diby, who set up an association called Wake Up Africa.

In Ivory Coast, heart disease, diabetes and other “lifestyle” ailments are surging, Diby explained. 

“Urbanisation is making people more sedentary, and there’s the rise in tobacco consumption, changes in diet, stress,” Diby said.

Three decades ago, only around one in eight of the Ivorian population had high blood pressure — now the figure is one in four, on a par with parts of Western Europe.

But in Ivory Coast — and across Africa — well-equipped cardiology units are rare.

“Ninety percent of heart attacks can be diagnosed by telemedicine, so for us cardiologists it’s a revolutionary technology,” said Diby.

The beauty of the telemedicine scheme is that neither the doctor nor the patient has to travel far. 

The cardiac patient is hooked up to the electrocardiogram (ECG) and other diagnostic machines with the help of a technician in a local health centre, which is connected to a computer in Bouake’s University Hospital. 

The cardiologist there can then see the results in real time, provide a diagnosis and prescribe treatment. 

The five-year-old project has already linked 10 health centres to the seven cardiologists at Bouake, enabling 4,800 patients in other towns to receive consultations by telemedicine each year. The goal is to expand this to 20 sites, doubling the intake.

Expertise France, the French public agency for international technical assistance, subsidises up to 185,000 euros of the network, which pays for equipment such as computers, artificial intelligence software and internet connections. 

Diby is now calling for telemedicine to be expanded in other medical fields such as neurology and psychiatry, not just in the Ivory Coast, but across West Africa too. 

That opinion is shared by other experts. Sixty per cent of Africans live in rural areas, where shortages of doctors are usually acute.

But numerous hurdles need to be overcome, especially investment in computers and access to the internet, according to a 2013 analysis published by the US National Library of Medicine. 

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Moroccan journalist arrested over “Illegal abortion”

Rights groups urged Moroccan authorities to release her, as her lawyers have firmly denied the “illegal abortion” charge.

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hajar raissouni
Hajar Raissouni. Photo credit - Amnesty.org

Hajar Raissouni writes for the Arabic-language daily Akhbar Al-Yaoum, which has a history of run-ins with the authorities.

She was arrested as she left a clinic in Rabat where her lawyer Saad Sahli said she had been undergoing treatment for internal bleeding. 

But the 28-year-old was examined by a medic and the prosecution said she showed signs of pregnancy and of having undergone a “late voluntary abortion”.

In a statement, it insisted her detention had “nothing to do with her profession as a journalist”.

On Friday, Rights groups urged Moroccan authorities to immediately release her, as her lawyers have firmly denied the “illegal abortion” charge.

Raissouni, who is religiously but not yet legally married, is also accused of having “sexual relations outside marriage” and faces a court hearing on Monday.

Her lawyers are lodging a complaint against police for forcing her to have a medical examination, her uncle Souleymane Raissouni told AFP.  

Also arrested were her fiancee, a doctor, a nurse and a secretary. 

Human Rights Watch and Amnesty International on Friday joined social media users in calling for her release.

“Instead of intimidating Hajar Raissouni by prosecuting her on unjust charges, the authorities should immediately and unconditionally release her,” said Heba Morayef, Amnesty’s regional director.

Ahmed Benchemsi, regional communications director at HRW, echoed Morayef’s call for all charges to be dropped.

The case had “a whiff of political manipulation since the defendant is a reporter from one of Morocco’s last newspapers,” he said.

Touafik Bouachrine, the owner of Raissouni’s newspaper, was sentenced in November to 12 years in prison on charges of rape and other offences.

He also denies all charges and his lawyers say his trial was politically motivated.

Raissouni’s arrest sparked heated debate online, and some 150 journalists signed a petition against “campaigns of defamation” against her.

Moroccan law punishes abortions with up to five years in prison, except in cases where the life of the mother is in danger.

However, NGOs say up to 800 women have clandestine abortions every day in the North African country.

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