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Women have been known to experience sexual dysfunction following major pelvic fractures and sacro-iliac disruption. In one study, women with vulvar vestibulitis reported more frequent problems and higher disress with genital pain, lubrication, sexual arousal and negative emotions in sexual interaction with their partners. Breast cancer has also been shown to induce sexual dysfunction among women. Erectile dysfunction among men in the general population between ages of 40 and 70 years is calculated at 52%. However, men with diabetes mellitus have impotence at an earlier age and with significantly higher prevalence, ranging as high as 75%. Antihypertensive and psychiatric medicines often cause impotence, as do hormonal causes.
Erectile dysfunction may be managed pharmacologically. A new wonder drug being discussed currently is sidenafil (Viagra) which is under development for the treatment of penile erectile dysfunction. Research has shown sidenfil to have suitable pharmacokinetic and pharmacodynamic properties (rapid absorption, relatively short half-life, no significant effect on heart rate and blood pressure)) for an oral agent to be taken, as required, prior to sexual response (duration and rigidity of erection) to visual sexual stimulation. Viagra has yet to gain universal approval by authorities. In Zambia, people have been cautioned that the government has not yet given the go-ahead to pharmacies to acquire and sell the drug for use in this country.
Highlighted in this issue also is an excerpt from a paper discussing the practice of "dry sex" which has some health repercussions which need to be weighed against the alleged merits of such sexual practice. Dry sex is a very topical subject locally and may need to be discussed at a wider level than has hitherto been done as it related on physical wellbeing.
Pharmacological treatment of erectile dysfunction includes all therapeutic modalities based on the use of erectogenic drugs, regardless of the route of administration. Intracavernous vasoactive injection therapy is the most commonly used treatment for erectile dysfunction. Most patients respond to intracavernous injection of either single or multiple vasoactive drugs. Major adverse effects related to this treatment include priapism, corporeal pain and the formation of nodules or plaques in the corpora cavernosa. Oral administration of drugs aimed at improving erectile function has not produced results comparable with those obtained with intracavernous injection therapy. However, in patients with psychogenic or mild organic impotence, oral treatment with drugs that influence either central or peripheral pathways controlling erection may improve erectile function. Topical administration of vasoactive drugs in the form of gels, liquid solutions or plasters is another attractive alternative for the treatment of psychogenic and mild organic erectile dysfunction. Although the ideal drug for the treatment of erectile dysfunction has not yet been identified, extensive laboratory and clinical research is ongoing and successful results are expected in the near future. [References: 59]
Montorsi F. Guazzoni G. Rigatti P. Pozza G. Pharmacological management of erectile dysfunction. [Review] [59 refs]
Drugs. 50(3):465-79, 1995 Sep.
Sexual dysfunction in primary medical care
Read S. King M. Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. Journal of Public Health Medicine. 19(4):387-91, 1997 Dec.
- BACKGROUND:
Despite the recent focus on sexual behaviour and AIDs, there are almost no data on the prevalence of sexual dysfunction within primary care settings.- METHOD:
One hundred and seventy patients attending a general practice participated in a questionnaire survey of the prevalence and characteristics of sexual problems. The detection rate of the general practitioners (GPs) and indicators in the patient notes were also investigated.- RESULTS:
Thirty five per cent of the men (n = 22) reported some form of specific sexual dysfunction: premature ejaculation was identified in 31 per cent of the men; 17 per cent experienced erectile dysfunction, which was associated with current medication, a high mean annual attendance and increasing age. The prevalence of sexual dysfunction in the women was 42 per cent (n = 41); vaginismus was reported by 30 per cent of the sample; 23 per cent of the women suffered from anorgasmia. General sexual dissatisfaction was more common than specific dysfunction; 68 per cent (n = 66) of the women and 75 per cent (n = 54) of the men reported at least one problem with dissatisfaction, avoidance, infrequency or non-communication. The large majority of the sample (70 per cent) considered sexual matters to be an appropriate topic for the GP to discuss. Despite this, sexual problems were recorded in only 2 per cent of the GP notes.- CONCLUSIONS:
This study confirms the high prevalence of sexual disorders in the population. Many of these problems are concealed from GPs. Predictors in patients' notes could help GPs to detect those patients with more serious problems.
Central African Journal of Medicine. 42(2):40-2, 1996 Feb.
Sexual dysfunction in women following pelvic fractures
We report the results of a postal questionnaire sent to a group of women who had sustained major pelvic fractures and sacroiliac disruption. The findings suggest that a large proportion of women suffer sexual dysfunction after such injuries. This is an important and previously neglected sequel of pelvic injuries.
Kiely N. Williams N. Sexual dysfunction in women following pelvic fractures with sacro-iliac disruption.
Injury. 27(1):45-6, 1996 Jan.
Sexual function in women with vulvar vestibulitis
Van Lankveld JJ. Weijenborg PT. ter Kuile MM. Psychologic profiles of and sexual function in women with vulvar vestibulitis and their partners.
- OBJECTIVE:
To compare psychologic profiles of women with vulvar vestibulitis and their partners with a normal population, and to identify sexual dysfunction in women and their partners.- METHODS:
Forty-three women with vulvar vestibulitis and 38 partners, recruited from a gynecology outpatient clinic, completed the Symptom Check List-90, the Short Dutch Version of the Minnesota Multiphasic Personality Inventory, the Maudsley Marital Questionnaire, and the Questionnaire for Screening Sexual Dysfunctions.- RESULTS:
The women with vulvar vestibulitis scored significantly higher on the somatization and shyness subscales than a normal population. They didn't differ in respect to their current level of psychologic distress, extraversion, risk of psychopathology, and marital satisfaction. Their partners had significantly lower scores for psychopathology than a normal population. They didn't differ from a normal population in respect to their level of psychologic distress, extraversion, shyness, somatization, and marital satisfaction. Women with vulvar vestibulitis reported more frequent problems and higher distress with genital pain, lubrication, sexual arousal, and negative emotions in the sexual interaction with the partner. During masturbation, however, they reported less frequent problems and distress. The partners of these women reported nearly no problems or distress in either sexual situation.- CONCLUSION:
Women with vulvar vestibulitis and their partners seem in general to be psychologically healthy, although vulvar vestibulitis may be associated with a situationally defined sexual dysfunction for the women.
Obstetrics & Gynecology. 88(1):65-70, 1996 Jul.
Dysfunction in treated breast cancer patients
Barni S. Mondin R. Sexual dysfunction in treated breast cancer patients [see comments].
- BACKGROUND:
This study examined the impact of breast cancer therapy on women's sexuality.- PATIENTS AND METHODS:
A questionnaire concerning various sexual problems experienced before and after treatment was anonymously completed by 50 women in the outpatient clinic of our hospital's Division of Radiation Oncology. To be eligible, subjects had to be disease-free and sexually active. They also had to have undergone surgery at least one year previously and have completed CT and or RT. Fifty-eight percent of the women involved had undergone mastectomy and 42% had undergone quadrantectomy followed by RT.- RESULTS:
Ninety percent of the subjects continued sexual activity after treatment, but there was an increase in the incidence of sexual problems which resulted in a slight reduction in the quality of their sex lives. Sixty-four percent of the women experienced an absence of sexual desire and 48% low sexual desire, while 38% had dyspareunia, 44% frigidity and 42% lubrication problems. Vaginismus, brief intercourse and female orgasmic disorder were reported by 30% of the subjects. Thirty-six percent suffered from sexual dysfunction before treatment, which worsened in about 27%, while in 49% of women sexual problems arose mainly after chemotherapy (26%) or surgery (12%). About one-half experienced changes in the relationship with their partner.- CONCLUSION:
Breast cancer patients experienced sexual dysfunction: ours found it easier to discuss the problems with their partner during their illness (62%) than with doctors and psychologists (15%)
Annals of Oncology. 8(2):149-53, 1997 Feb.
Sildenafil (Viagra) in treatment of penile erectile dysfunction
Sildenafil (Viagra, UK-92,480) is a novel oral agent under development for the treatment of penile erectile dysfunction. Erection is dependent on nitric oxide and its second messenger, cyclic guanosine monophosphate (cGMP). However, the relative importance of phosphodiesterase (PDE) isozymes is not clear. We have identified both cGMP- and cyclic adenosine monophosphate-specific phosphodiesterases (PDEs) in human corpora cavernosa in vitro. The main PDE activity in this tissue was due to PDE5, with PDE2 and 3 also identified. Sildenafil is a selective inhibitor of PDE5 with a mean IC50 of 0.0039 microM. In human volunteers, we have shown sildenafil to have suitable pharmacokinetic and pharmacodynamic properties (rapid absorption, relatively short half-life, no significant effect on heart rate and blood pressure) for an oral agent to be taken, as required, prior to sexual activity. Moreover, in a clinical study of 12 patients with erectile dysfunction without an established organic cause, we have hown sildenafil to enhance the erectile response (duration and rigidity of erection) to visual sexual stimulation, thus highlighting the important role of PDE5 in human penile erection. Sildenafil holds promise as a new effective oral treatment for penile erectile dysfunction.
Boolell M. Allen MJ. Ballard SA. Gepi-Attee S. Muirhead GJ. Naylor AM. Osterloh IH. Gingell C. Sildenafil, an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction.
International Journal of Impotence Research 8(2) 47-52, 1996 June
Drugs for the treatment of impotence vaccine
Penile erection is a complex neurovascular event that represents a balance between corporal smooth muscle relaxation and contraction. This balance is determined by the interaction between proerectile and antierectile neurotransmitters. It is believed that nitric oxide is the primary erectogenic neurotransmitter and that noradrenaline (norepinephrine) is the primary erectolytic neurotransmitter. There are a number of pharmacological approaches to the management of erectile dysfunction and manipulation of the neurotransmitter systems. These involve direct delivery of drugs into the erectile chambers (intracavernosal injection therapy), administration of medications into the urethra (transurethral delivery), application of medications to the skin (transdermal delivery) and it is hoped that oral agents will be available in the very near future. This article reviews the world literature on the medications that have been investigated to date and their delivery routes. [References: 98]
Evans DB. Guyatt HL. Garcia-Reboll L. Mulhall JP. Goldstein I. Drugs for the treatment of impotence. [Review] [98 refs]
Drugs & Aging. 11(2):140-51, 1997 Aug.
Implant for treatment of impotence programmes
Penile implants are used for erectile dysfunction (ED). Their main disadvantage is that the cavernous tissue is destroyed and replaced by fibrous so that implant replacement is difficult and the penis loses its erectile function permanently. This paper describes a novel prosthesis which is hollow and fenestrated to preserve, as much as possible, the cavernous tissue. The fenestrated implant was used in 18 men with ED, while the solid Small-Carrion implants were used in 14 impotent men who matched the 18 men in age and cause of impotence and acted as controls. Routine erectile function tests suggested that the ED was neurogenic. The fenestrated prosthesis was a hollow semisolid silicone rod with multiple openings (2-3 mm in diameter) along its whole length. The mean follow up of the patients was 43 +/- 12 SD months. No complications were encountered. Vaginal penetration was successful in the fenestrated and Small-Carrion implant groups. A total of 14/18 patients of the fenestrated prosthesis group experienced spontaneous erections upon sexual arousal, while none of the Small-Carrion prosthesis group did. During the sexual act the penis became tumescent in the patients of the former group but not in those of the latter. It is suggested that the residual cavernous tissue after insertion of the hollow fenestrated implant regenerates through the fenestrae into the implant lumen. This might explain the spontaneous erections upon sexual arousal and the tumescence during the sexual act, but this hypothesis remains to be proved histologically. Shafik A. Hollow and fenestrated penile prosthesis: a new implant for treatment of impotence
Archives of Andrology. 38(1):93-8, 1997 Jan-Feb.
Diabetic sexual dysfunction
Although the overall incidence of erectile dysfunction in the general population between the ages of 40 and 70 years is 52%, men with diabetes mellitus have impotence at an earlier age and with a significantly higher prevalence, ranging as high as 75%. Numerous advances have been made in understanding the physiologic and biochemical mechanisms controlling penile erection. Improved clinical techniques for the diagnosis and treatment of impotence, including dynamic vascular testing, intracavernosal pharmacotherapy, and microsurgical revascularization, have allowed us to enter a new and exciting era in the quest for a more complete understanding of erectile dysfunction. [References: 133]
Hakim LS. Goldstein I. Diabetic sexual dysfunction. [Review] [133 refs] Endocrinology & Metabolism Clinics of North America. 25(2):379-400, 1996 Jun.
Penile prosthesis in case of impotence
Among 95 patients who have received a penile prosthesis between 1982 and 1993 (mean follow up of 46 months), 21 (22%) presented complications requiring one or more reintervention(s). Only for two patients the problem was mechanical, in the majority, they were non mechanical. Five of those subjects (5.5%) presented such complications that definitive explanation of the device was necessary. The problems presented by the 9 remaining patients were fully satisfactorily managed. Presently 94.5 per cent of the patients are using the device. Follow-up study of our interdisciplinary group demonstrates the efficacity of the prosthesis for revitalisation of the couples. The definitive parameters of implantation acceptance are essentially the partner influence and the treatment cost. This clinical study shows that the implantation of a penile prosthesis is an effective therapy in the treatment of impotence in a selected population. Presently, the mechanical reliability of different device has been good to date.
Andrianne R. Balde S. de Leval J. Kempeners P. Mormont C. Penile prosthesis in case of impotence: 12 years of clinical experience].
Acta Urologica Belgica. 63(1):89-96, 1995 Mar.
Assessment & treatment of impotence
Impotence is a common problem. History is primarily relied on to diagnose psychogenic impotence. Sex therapy is an effective treatment. Antihypertensive and psychiatric medicines often cause impotence, but most medicines should be considered a cause if this is supported by the history. Hormonal causes should be suspected in a patient with decreased libido or decreased testicular size, and testosterone should be measured in these cases. Hormone replacement may restore sexual function in hypogonadal men. Doppler sonogram or arteriography should be used to diagnose vascular impotence for men who would be good surgical candidates. Only young men without other illness are considered. There is little need to test neurologic function because there is no specific treatment for neurogenic impotence. These patients and patients who do not respond to the aforementioned treatments should be offered the vacuum erection device, penile self-injection therapy, or penile prosthesis. Choice depends on comorbid illness as well as patient preference. A basic algorithm for the evaluation and treatment of impotence is given in Figure 2.
Magnussen P. Muchiri E. Mungai P. O'Keefe M. Hunt DK. Assessment and treatment of impotence. [Review] [104 refs]
Medical Clinics of North America. 79(2):415-34, 1995 Mar.
Effects of sidenafil (viagra)
Ballard SA. Gingell CJ. Tang K. Turner LA. Price ME. Naylor AM. Effects of sildenafil on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic nucleotide phosphodiesterase isozymes.
- PURPOSE:
Sildenafil, an inhibitor of cGMP-specific phosphodiesterase 5 (PDE5), is currently undergoing evaluation as an oral therapy for penile erectile dysfunction. The aims of this study were to investigate the mechanism of action of sildenafil on the neurogenic relaxation of human corpus cavernosum (HCC) in vitro and to determine the activity of sildenafil against a full range of PDE isozymes.- MATERIALS AND METHODS:
Strips of HCC tissue were precontracted with phenylephrine. Relaxation responses resulting from electrical field stimulation (EFS) were then determined in the presence and absence of sildenafil. The effects of sildenafil on PDE1 to 5 prepared from human tissues and PDE6 from bovine retina were determined by measuring the conversion of [3H]-cGMP or [3H]-cAMP to their respective [3H]-5'-mononucleotides.- RESULTS:
Sildenafil (0.001 to 1 microM)enhanced the EFS-induced, nitric oxide (NO) dependent, relaxation of HCC in a concentration-dependent manner to a maximum of 3 times the pretreatment level at 1 microM sildenafil. Compared with zaprinast, an early PDE5 inhibitor, sildenafil was approximately 240-fold more potent, inhibiting PDE5 from HCC with a geometric mean IC50 of 3.5 nM. For sildenafil, IC50 values for inhibition of PDE1 to 4 were 80 to more than 8500 times greater than that for PDE5 and the IC50 for PDE6 (33 nM) was approximately 9-fold greater.- CONCLUSIONS:
The data support the proposal that enhancement of penile erection by sildenafil in patients with erectile dysfunction involves potentiation of the NO-stimulated cGMP signal mediating relaxation of cavernosal smooth muscle during sexual stimulation. Sildenafil is a potent inhibitor of PDE5 from HCC, with high selectivity for PDE5 relative to other PDE isozymes.
Journal of Urology. 159(6):2164-71, 1998 Jun.
Sidenafil, inhibitor of phosphodiesterase type 5
In human corpus cavernosum, release of nitric oxide from the non-adrenergic, non-cholinergic nerves and/or the endothelium activates guanylyl cyclase and increases intracellular cGMP levels. The increase in intracellular cGMP modulates intracellular calcium and in turn regulates smooth muscle contractility and erectile function. Phosphodiesterases play an important physiological role by regulating the intracellular levels of cyclic nucleotides. In this study, we investigated the kinetic parameters of inhibition of phosphodiesterase (PDE) type 5 (E.C. 3.1.4.35 3',5'-cyclic GMP phosphodiesterase) by a novel, high affinity, selective PDE type 5 inhibitor, sildenafil, in soluble extracts of human corpus cavernosum smooth muscle cells. Sildenafil inhibited PDE type 5 cGMP-hydrolytic activity, in the crude extract (Ki=4-6 nM) and in partially purified preparations (Ki=2 nM) in a competitive manner, as determined by Dixon plots. Sildenafil (Ki=2-4 nM) was a more effective PDE type 5 inhibitor than zaprinast (Ki=250 nM). Stimulation of intracellular cGMP synthesis by the nitric oxide donor, sodium nitroprusside, resulted in less than a 5% increase in cGMP levels in the absence of sildenafil and a 35% increase in cGMP levels in the presence of sildenafil, in intact cells at physiological temperatures. These results are in accord with the clinical observations that sildenafil, taken orally, promotes penile erection through increased intracellular cGMP in response to sexual stimulation, potentiating smooth muscle relaxation.
Moreland RB. Goldstein I. Traish A. Sildenafil, a novel inhibitor of phosphodiesterase type 5 in human corpus cavernosum smooth muscle cells
Life Sciences. 62(20):PL 309-18, 1998.
Oral sildenafil in treatment of erectile dysfunction
- BACKGROUND:
Sildenafil is a potent inhibitor of cyclic guanosine monophosphate in the corpus cavernosum and therefore increases the penile response to sexual stimulation. We evaluated the efficacy and safety of sildenafil, administered as needed in two sequential double-blind studies of men with erectile dysfunction of organic, psychogenic, and mixed causes.- METHODS:
In a 24-week dose-response study, 532 men were treated with oral sildenafil (25, 50, or 100 mg) or placebo. In a 12-week, flexible dose-escalation study, 329 different men were treated with sildenafil or placebo, with dose escalation to 100 mg based on efficacy and tolerance. After this dose-escalation study, 225 of the 329 men entered a 32-week, open-label extension study. We assessed efficacy according to the International Index of Erectile Function, a patient log, and a global-efficacy question.- RESULTS:
In the dose-response study, increasing doses of sildenafil were associated with improved erectile function (P values for increases in scores for questions about achieving and maintaining erections were <0.001). For the men receiving 100 mg of sildenafil, the mean score for the question about achieving erections was 100 percent higher after treatment than at base line (4.0 vs. 2.0 of a possible score of 5). In the last four weeks of treatment in the dose-escalation study, 69 percent of all attempts at sexual intercourse were successful for the men receiving sildenafil, as compared with 22 percent for those receiving placebo (P<0.001). The mean numbers of successful attempts per month were 5.9 for the men receiving sildenafil and 1.5 for those receiving placebo (P<0.001). Headache, flushing, and dyspepsia were the most common adverse effects in the dose-escalation study, occurring in 6 percent to 18 percent of the men. Ninety-two percent of the men completed the 32-week extension study. CONCLUSIONS: Oral sildenafil is an effective, well-tolerated treatment for men with erectile dysfunction.
Goldstein I. Lue TF. Padma-Nathan H. Rosen RC. Steers WD. Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group [see comments]
New England Journal of Medicine. 338(20):1397-404, 1998 May 14.
Sildenafil in treatment of penile erectile dysfunction
Sildenafil (Viagra, UK-92,480) is a novel oral agent under development for the treatment of penile erectile dysfunction. Erection is dependent on nitric oxide and its second messenger, cyclic guanosine monophosphate (cGMP). However, the relative importance of phosphodiesterase (PDE) isozymes is not clear. We have identified both cGMP- and cyclic adenosine monophosphate-specific phosphodiesterases (PDEs) in human corpora cavernosa in vitro. The main PDE activity in this tissue was due to PDE5, with PDE2 and 3 also identified. Sildenafil is a selective inhibitor of PDE5 with a mean IC50 of 0.0039 microM. In human volunteers, we have shown sildenafil to have suitable pharmacokinetic and pharmacodynamic properties (rapid absorption, relatively short half-life, no significant effect on heart rate and blood pressure) for an oral agent to be taken, as required, prior to sexual activity. Moreover, in a clinical study of 12 patients with erectile dysfunction without an established organic cause, we have shown sildenafil to enhance the erectile response (duration and rigidity of erection) to visual sexual stimulation, thus highlighting the important role of PDE5 in human penile erection. Sildenafil holds promise as a new effective oral treatment for penile erectile dysfunction.
Boolell M. Allen MJ. Ballard SA. Gepi-Attee S. Muirhead GJ. Naylor AM. Osterloh IH. Gingell C. Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction.
International Journal of Impotence Research. 8(2):47-52, 1996 Jun.
Sidenafil: oral therapy for male sexual dysfunction
Boolell M. Gepi-Attee S. Gingell JC. Allen MJ. Sildenafil, a novel effective oral therapy for male erectile dysfunction
- OBJECTIVES:
To determine the efficacy and safety of sildenafil, a novel orally active inhibitor of the type-V cyclic guanosine monophosphate-specific phosphodiesterase (the predominant isoenzyme in the human corpus cavernosum) on penile erectile activity in patients with male erectile dysfunction of no established organic cause.- PATIENTS AND METHODS:
Twelve patients (aged 36-63 years) with male erectile dysfunction of no established organic cause were entered into a double-blind, randomized, placebo-controlled, crossover study which was conducted in two phases. In the first phase (four-way crossover), treatment efficacy was evaluated by measurements of penile rigidity using penile plethysmography during visual sexual stimulation at different doses of sildenafil (10, 25 and 50 mg or placebo). In the second phase (two-way crossover), efficacy was assessed by a diary record of penile erectile activity after single daily doses of sildenafil (25 mg) or placebo for 7 days.- RESULTS:
The mean (95% confidence interval, CI) duration of rigidity of > 80% at the base of the penis was 1.3 min (0.4-3.1) in patients on placebo, 3.5 min (1.6-7.3; P = 0.009) on 10 mg, 8.0 min (3.7-16.7; P = 0.003) on 25 mg and 11.2 min (5.6-22.3; P < 0.001) on 50 mg of sildenafil. The mean (95% CI) duration of rigidity of > 80% at the tip of the penis was 1.2 min (0.4-2.7) on placebo and 7.4 min (2.4-8.5; P = 0.001) on 50 mg sildenafil. From the diary record of daily erectile activity, the mean (95% CI) total number of erections was significantly higher in patients receiving sildenafil was 6.1 (3.2-11.4), compared with 1.3 (0.5-2.7) in those on placebo; 10 of 12 patients reported improved erectile activity while receiving sildenafil, compared with two of 12 on placebo (P = 0.018). Six patients on active treatment and five on placebo reported mild and transient adverse events which included headache, dyspepsia and pelvic musculo-skeletal pain.- CONCLUSION:
These results show that sildenafil is a well tolerated and effective oral therapy for male erectile dysfunction with no established organic cause and may represent a new class of peripherally acting drugs for the treatment of this condition.
British Journal of Urology. 78(2):257-61, 1996 Aug.
The underlying assumptions of this study was that men's opinions and sexual behaviour would depend on some demographic factors such as age, marital status, religion, type of school (whether mission or government) one attended, ethnic group, residence and pre-marital counseling status. The objective of the study focused on determining the extent men encouraged their spouses to practice dry sex' and how much the men liked the practice. It also explored men's opinions if their spouses stopped the sexual practice. The study tried to make some inferences on the possible role the sexual practice has in facilitating acquisition of AIDS by the population concerned.
Men's opinion and their role in dry sex'practice:
The men seemed aware that women use herbs to dry
the water' and make the birth canal smaller and
considered the practice normal as it consolidated
their relationships or marriages. However, some men
felt it was not good for the women to use herbs as
most of the time if they were not washed out properly,
they cause bruises on the penis during sexual
intercourse. So they advocated for their women folk
to use ordinary cold water to wash their genitalia just
before sexual intercourse instead.
Upon probing further on why men insisted that women should have a tight and dry birth canal when biologically it is normal for a woman to have some water', most of the men attributed it to the fact that they have been socialised by traditional elders that a woman should not have any water'. The presence of water' is considered as an illness and the woman is asked to look for help or treatment from the elders.
The presence of water' is a hindrance to the man's sexual performance. Traditionally manhood is measured by the number of rounds' a man would have with his spouse during sexual intercourse. The fewer the rounds' the weaker the man is considered to be. The researcher was privileged to hear some of the bad terms used to describe a woman with water'. This confirms the sentiments expressed by women in the U.T.H. study as to why they practiced dry sex'.
Whose choice is the sexual practice?
Forty percent (40%) (30) of the respondents admitted
that they played a major role in choosing the sexual
practice while 11 (13%) said that it was their partner's
choice. Forty seven percent (47%) said the choice
was dictated by cultural beliefs through the traditional
elders. A woman plays a passive role in a traditional
African society when it comes to sexual matters.
Effects of the demographic factors:
The study results showed that among the married
respondents dry sex' practice was more in the age
group 31-40 (as shown in table 7) whilst among the
single respondents it was more for those aged 30 and
below. The two demographic variables; age and
marital status, have no significant effect on the sexual
practice. The practice was favoured by all age
groups and was more in the young and middle aged.
This was mostly probably because they are sexually
active. However, there was some significance
between one's residential area and one's choice of
sex practice. The dry' sexual practice was popular in
all residential areas. This seemed to support the
phenomena that for any cultural value to have impact
on the individual it demands adequate socialisation
for that individual to function in accordance with the
dictates of the culture, so does this traditional sexual
practice. The men in urban areas are known for
double standards and because of this, they have
been socialised in various sexual practices even
those which do not necessarily depict one's ethnic
origin. The mutual nature of doing things engenders
a mutual affection. So, in such a situation, what one
knows becomes common knowledge for the whole
community. Hence the widespread of the sexual
practice regardless of the residential area.
The results of the study show that educational level and type of marriage does not seem to affect the preference for dry sex' practice. Those who attained secondary education and were either traditionally married or married under the Civil Act, were for dry sex' practice. Educational attainment has not changed the sexual behaviour and values. This illustrates that there are a lot of issues and phenomena these societies have faith in. The majority of such beliefs defy any scientific explanation and investigation.
The findings further showed that there was some significant difference in sexual practice between respondents who were at mission schools and those at government schools. The majority of respondents who were at government schools easily went for dry sex' as compared to their counterparts from mission schools. The researcher attributed this to probably the stringent measures and emphasis on chastity of mission schools which could have tamed their values.
Religious affiliation did not seem to have effect on the choice of sexual practice. The practice was common in almost all denominations including those who professed to be highly devoted to their faith. Traditionally all tribes in Zambia believe in the existence of supernatural power from whom all life originates. This is the belief the missionaries capitalised on when they came to this country. This belief in a supernatural being contributed immensely to the totality of the people's regulation of life and expectations. The researcher noted that despite this background and the fact that some confessed being highly devoted to their faith, this did not change their traditional value of dry sex' practice.
The married respondents with premarital counseling status were more for dry sex' practice as opposed to those who did not receive any premarital counseling. The researcher observed that those who passed through the traditional elders were more inclined to the sexual practice. This was because certain tabboos and their gravity with regard to sex were shared to them and obedience insulated the individuals against an anticipated problem. For instance a young man is warned not to eat fatty mice as the fat would close the way in the penis and render one impotent. So, such threats would force most men to abide by the traditional elders' instructions. In situations whereby conformity is a priority and wherein different forces interplay and regulate an individual's behaviour, obedience without questioning becomes common.
The practice was widespread in respondents of almost all provinces with Eastern Province topping the list. The researcher noted that the practice was common in all tribes even where there was no ethnic trace from where some individuals originate. This is because of the intermingling of various tribes in Lusaka urban. This intermingling has made mockery of the cultures they prophesy to operate it.
Reasons for perpetuating dry sex' practice:
Various reasons were given for preferring dry sex' to
normal wet sex'. The major reasons were as
follows:
From what has been outlined it is very clear that the men play a major role in perpetuating this sexual practice. The major thing which comes out is that they seem to be selfish, wanting to have all the sexual pleasure to themselves without considering what a woman goes through to create that phenomena.
The men seem to be ignorant or pretend to be ignorant of the normal sexual physiology of a woman. This is seen in the way they insist that a woman shouldn't have any water' and that the presence of water' is an indication of an illness or a sign of being dirty.
Implications on AIDS prevention and control:
The sexual practice has been found to be associated
with the transmission of AIDS. The current health
education materials in the country do not include
information on the practice. So, there is need to
revise the health educational materials to incorporate
the traditional practice. If this is not done the efforts
on prevention and control will be fruitless.
There is need to equip the health personnel who are always in contact with the community with more knowledge on the relationship between the sexual practice and AIDS. This will enable them to utilise every encounter with the community to educate them on the sexual practice and increase community education coverage.
The traditional and church counsellors will be involved in the national campaigns on AIDS . They will need to be educated on the adverse effects of some of the traditional values and practice in relation to AIDS. The root cause of the problem should be explored so that it is dealt with first. This will require a comprehensive analysis of historical and social-economic features of the society. The school health services will have to diversify to include sex education. This is because some of these traditional practices are taught during adolescence. So, if they are exposed to appropriate health education materials, it will contribute to the control of AIDS.
The study sought to explore men's opinions and their role in the dry sex' practice among women. The study revealed that men played a major role in perpetuating the practice of dry sex'. The main reason for encouraging the dry sex' practice among women was to enhance mutual sexual pleasure. This was an indication that men lack knowledge of the normal sexual physiology. It also identified the need for women to be armed with equal powers of decision over sex as their male counterparts. It was established that some demographic characteristics such as educational level, religious affiliation did have some significant relationship with a tendency to practice dry sex'. The sexual practice cuts across social, economic and ethnic backgrounds.
After health education on the relationship of the traditional practice with AIDS, 13% vowed to continue encouraging the practice while 76% reluctantly said they would stop the practice and 11% opted to reduce the frequency of the practice. This supported the notion that changing life style is not an easy task. This is because sexual behaviour is affected by the combination of values, cultural guidelines, perceptions and practicalities that occur in a particular socio-cultural and economic setting. More specifically sexuality is subject to a number of conscious and unconscious influences, social, psychological and economic reasons, more powerful than even the fear of disease. It is evident from the findings that people need more facts about AIDS to enable change their sexual behaviour.
[Excerpt from a research study submitted by the author in partial fulfilment of the Bachelor's Degree in Nursing Sciences - UNZA, 1992]
What is the difference between Mechanical Engineers and Civil Engineers? Mechanical Engineers build weapons, Civil Engineers build targets.
Three engineering students were gathered together discussing the possible designers of the human body. One said, "It was a mechanical engineer. Just look at all the joints." Another said, "No, it was an electrical engineer. The nervous system has many thousands of electrical connections." The last said, "Actually it was a civil engineer. Who else would run a toxic waste pipeline through a recreational area?"
An engineering student was walking across campus when another engineer rides up on a shiny new motorcycle. "Where did you get such a great bike?" asked the first. The second engineer replied "Well, I was walking along yesterday minding my own business when a beautiful woman rode up on this bike. She threw the bike to the ground, took off all her clothes and said 'Take what you want.'" The first engineer nodded approvingly "Good choice; the clothes probably wouldn't have fit."
It seems that every Friday morning a cleaner would enter the ward, remove the plug that powered the patient's life support system, plug her floor polisher into the vacant socket, then go about her business. When she had finished her chores, she would plug the life support machine back in and leave, unaware that the patient was now dead. She could not, after all, hear the screams and eventual death rattle over the whirring of her polisher...
"We are sorry, and have sent a strong letter to the cleaner in question. Further, the Free State Health and Welfare Department is arranging for an electrician to fit an extra socket, so there should be no repetition of this incident. The inquiry is now closed." (Cape Times) BTW, the headline of the newspaper story was, "Cleaner Polishes off Patients."
As always, prevention is the first and the best strategy. This includes ongoing education about safe sex, condom use and about staying with one partner who has no other partners, as well as early and complete treatment for all STDs.
If for any reason a client who is pregnant suspects that she might be HIV positive, we should first discuss with her the possibility of going for voluntary HIV counselling and testing, if it is available in your district. You should always encourage her partner come with her. If she tests positive she will need more support and counselling. If she decides to have a Termination of Pregnancy, our role is one of supporting her decision and making the procedure as easy as possible for her and her family.
The HIV positive woman who decides to have her baby needs to be counselled about the likelihood that her baby might also have HIV. Researchers estimate thE rates of HIV transmission from mother to child are between 25% and 45% in developing countries. She needs to be prepared to deal with this if it happens.
She also needs to decide about breastfeeding. Recent data from developing countries indicates that up to one half of mother-to-child HIV transmission is due to breastfeeding. We still promote breastfeeding for all mothers because it saves more baby's lives than almost any other intervention. But if a mother is definitely HIV positive and has the resources to artificially feed her baby, we should be prepared to help her with this decision. For a full discussion of breastfeeding and HIV, please see the March, 1998 Issue of Reproductive Health News.
Research about how HIV affects pregnancy and how pregnancy affects HIV and AIDS is still inconclusive. However, as with any antenatal client, we should watch for and treat infections quickly and fully, especially STDs. During delivery we should be especially careful about infection control. As there is some evidence that vertical transmission is more likely if labour goes on for 4 hours after the membranes rupture, we should not artificially rupture the membranes.
After the woman has had her baby, post-partum care is also important asthis is often a time when infection occurs. In addition, this woman will need on going support, especially if she and/or her baby develop AIDS. Post-partum depression is a risk in all mothers. HIV positive mothers are probably more vulnerable since HIV does not affect fertility. A key component of post-partum care is the promotion of both an effective method of family planning and safe sex strategies including condoms.
References: Integrated Technical Guidelines for Frontline Healthworkers; Safe Motherhood in Reproductive Health: Policy, Guidelines and Standards.
The risk of infection through breastfeeding needs to be weighed against the great dangers posed by artificial feeding. In communities where sanitation is inadequate and families are poor, death from diarrhoea is 14 times higher in artificially fed infants than in those who are breast fed. If HIV - positive women and those who fear HIV(without actually being infected) were to abandon breastfeeding in large numbers, without safe and reliable alternatives for feeding their children, the ensuring infant deaths from diarrhoea and respiratory infections could vastly out - number those from HIV.
The dilemma facing an HIV - positive woman who does not have easy
access to safe water, who does not have enough fuel to sterilize feeding bottles and
prepare alternatives to breast milk, or who cannot afford to buy sufficient
formula to ensure her child's nutrition is a wrenching one which no
mother can solve on her own. Support for mothers facing this dilemma is
imperative, as the Joint United Nations Programme on HIV / AIDS
(UNAIDS) made clear in 1996. The following measures are important starting points.
Pregnant women should have access to voluntary and confidential
counselling and testing to determine their health status . If they are HIV positive ,
they should receive appropriate treatment to reduce the risk of vertical
transmission. If they are HIV negative, health education is vital to help
them and their partners remain that way. HIV - positive mothers should be informed of the risk of both vertical transmission through breastfeeding and infections associated with artificial feeding in their local environment. Each woman should be assisted by
HIV counsellors or health professionals to understand these risks and then
make her own decision.
If an HIV - positive mother has access to adequate breast milk substitutes that she can prepare safely, then she should consider artificial feeding. Other alternatives include wet - nursing by an HIV - negative woman, which may be acceptable in some cultures. Heat treatment of expressed breast milk (62.5 c for 30 minutes) destroys the virus, which may be a good choice for some women. These measures should be part of an integrated strategy to reduce vertical transmission since breast feeding is only a small part of the problem.
Access to voluntary, confidential testing and counselling is key to any strategy to reduce vertical transmission. Access to range of prenatal and obstetric care measure associated with reduced transmission risk is also essential. Studies now in progress will soon give a better understanding of the mechanisms, timing and risks of vertical transmission. It may be possible in a few years to offer all women low - cost, easily delivered services that will minimize or even eliminate the risk of vertical transmission. For now, access to the testing, counselling, information and other services noted above should be high priorities.
Adapted from the State of the World's Children Report, 1998
Because we never know if an infection is present in our clients, we must always take precautions against becoming infected ourselves or infecting our clients. Infection prevention procedures must be part of every thing that we do. Wash your hands before and after every client contact. Hand washing is the single most important thing that you can do to prevent infections. Use soap and water and rub your hands for 10 to 15 seconds. A quick rinse is not good enough. Dry your hands with a clean cloth or paper towel. In many health centres, where there are water shortages, this does present difficulties, but they are ones that must be overcome. A basin of water should be in every delivery, examination, treatment and injection room.
Gloves should be worn whenever you need to touch broken skin, mucous membranes, blood or any other body fluids. This includes touching and cleaning equipment or instruments that are soiled or have been in contact with blood or body fluids. For examinations and cleaning, clean, but not necessarily sterile gloves can be used. For surgery, including suturing, you must use sterile gloves. It is also advisable to use sterile gloves for deliveries. Gloves should be changed and hands washed after each patient contact. For example, after a pelvic examination, you should remove your gloves and wash your hands before writing on the patient record. If sterile surgical gloves are washed and re-sterilised for re-use, you should double gloves for procedures where there is contact with blood or body fluids, for example deliveries. This is because tiny invisible tears can occur during the washing and re-sterilising process. Wear masks and plastic aprons whenever there is a risk that you might be splashed with blood or body fluids, for example deliveries. Never eat or drink or put anything in your mouth in any place where there might be blood.
Instruments must the de-contaminated and sterilised after every use. After a pelvic examination or delivery, instruments used must be put in a solution for de-contamination (usually Jik) right away. Always be sure that your steriliser is working properly and follow the instructions on how to use it. Unwrapped instruments need to be sterilised for 20 minutes, wrapped ones for 30. Cord cutting must always be done with a sterile instrument, even if it is a razor blade. Beds and table surfaces must be wiped down with a disinfectant, usually Jik. This should be done right away and before you bring another client into the room. You should wear gloves while you do it.
Rubbish like swabs and cotton should be disposed of safely and burned. Cleaners who come in contact with contaminated rubbish should wear gloves. Prevent needle stick injuries by disposing needles safely. Immediately dispose of disposable needles in a sharp container. Do not cap the needle. If for some reason you need to cap a needle, put the cap on a table or some other hard flat surface and guide the needle into the cap without touching the cap. Put sharps containers in all patient areas. If you don't have a special sharps container, any sturdy box or bottle, even a Jik bottle, will do. When sharps containers are full, securely close them with cello or other tape and dispose the whole container. Never empty and re-use a sharps container. If you need to re-use needles, immediately after using a needle, put it in a de-contamination solution. Be very careful about cleaning and sharpening needles. It is up to all of us to create a safe environment for our patients, our colleagues and ourselves.
References: Integrated Technical Guidelines for Frontline Health workers; Safe Motherhood in Reproductive Health: Policy, Guidelines and Standards; and Outlook, vol. 15, no 4.
The current trends in world development have taught us to have a new respect for a profession that has existed for a long time but which only now has come into its prime particularly in this part of the world. We have all at various stages of our educational careers passed through the hands of a number of librarians bvut we never really stopped to give credit for how the service we received changed our lives. We have taken everything for granted.
Accelerated development at the global level has spurned unprecedented levels of generation of information commonly referred to as the information explosion. Volumes and volumes of information of various disciplines is being produced daily. I should state that this is very vital information without which development and progress is seriously impaired. However, the headache is how to make this information easily manageable for the end user who lack the skills of methodically going through to isolate only that bit which is useful for their particular purpose. Information management as a discipline is constantly evolving to fill in this need. As long as there are competent professionals who we can all trust to go into the jungle of information and ensure that we receive our information in bite size, we shall all have peaceful times doing what we need to do without extra worries.
I note that the theme of the biennial is: health promotion through information dissemination: a strategy for the future. The Ministry of Education has a large stake in the outcome of this conference that you are embarking on. Some among you may be wondering where the link is between health and education. It is very simple and fundamental.
Earlier I made reference to schools of medicine. Doctors are trained by educators. There are those in the fraternity whose talent, interest and personal persuasion has directed them toward the honourable practice of teaching our health personnel in training. The University of Zambia's School of Medicine is staffed by many such honourable men and women who the whole nation is grateful to for producing yearly crops of doctors and other health professionals to fill our desperate need for health service providers. They perform their duties under constraints that the ministry of education is aware of, and yet our gradutes are some of the best crop of graduates on the continent. The University of Zambia School of Medicine has a very high reputation among schools of medicine world over. Allow me to take this opportunity to recognise the work being performed by the dean of the school of medicine and his hardworking faculty.
Education, however, goes beyond the education of nurses and doctors.In Zambia, we have had to do some radical re-thinking of the roles of government, communities and individuals in health service provision during an exercise dubbed the health reforms. We established from the outset that there is a distinct correlation between the level of health status of a community and their level of education.
To illustrate this: the Zambia Demographic and Health Survey (ZDHS) confirmed that there is a strong association between women's level of education and virtually all social indicators. A particularly important instance is with respect to the standard of maternal care women obtain. Educated women have greater accress to modern care and better understanding of its importance and how to make use of it. Nearly one fifth of live births by uneducated mothers had received no antenatal care and antenatal care was rarely attended by a doctor. In contrast, about one fifth of births by women with higher education obtain antenatal care from a doctor and virtually all receive antenantal care.
Similarly, the ZDHS found that only one third of
uneducated mothers obtained the necessary tetanus
toxoid injection during pregnancy (i.e. two or more
doses), as compared with two thirds of mothers with
higher eduaction; three quaarters of births by
uneducated mothers were delivered at home,
whereas 96 percent of births by mothers with higher
education were delivered at a health facility; and only
about one fifth of deliveries by uneducated mothers
are assisted by a trained nurse, midwife or doctor, as
compared with 95 percent of mothers wiTh higher
education.
As we grapple with educational reform, therefore, we
are mindful of the fact that perormance in education
is expected to have a major influence on health
status, fertility and household hygiene, and
represents a basic tool for the avoidance of or, better
still, alleviation of poverty.
The Ministry of Education recognises the crucial role played by librarians and other practitioners in information provision as partners in ensuring that our dreams for a better quality of life for our people becomes a reality. Indeed this is the major reason that has brought all of you here from far and wide, to strategise on how you can react to the demands of the next millenium in your quest for adequate and effective provision of health information. The year 2000 is just around the corner. Barring any unexpected twists, most of us in this room today will certainly be there to welcome the new miilenium and learn how to write 2000 instead of nineteen something, a strange development.
While we are on the subject of the year 2000, I do hope that among the issues you will be discussing will be the question of computers failing to work after 31st december 1999. We in Zambia have developed a very healthy affinity for the possibilities that computers open up for development. The threat of losing all our computers at the turn of the century is extremely worrying. I expect that professionals like you will have found the answer before the fateful day arrives.
I am informed that this conference has been funded by the World Health Organisation Afro office. On behalf of the people of Zambia, I wish to thank WHO-AFRO for their generosity. Serious economic constraints are making it difficult for countries like ours to be able to fund events of this nature, much as we would like to. Our good intentions are not supported by practical means. I am also informed that the Embassy of Sweden made a contribution to the conference budget. I salute our Swedish friends for their consistency in supporting us whenever we are in need. Thank you all.
Furthermore, there have been some contributions by individuals towards the realisation of this meeting. My heart is touched by such personal generosity that moved people to reach out for their pockets and give to the success of this conference. May God give you back a thousandfold what you have kindly offered. Ladies and gentlemen, I now wish to declare the 6th biennial of the Association for Health Information & Libraries in Africa (AHILA) officially open. I wish you successful deliberations and interaction. May God bless your efforts.
The next AHILA Biennial will be hosted by Swaziland in the year 2000!
Responses & Reactions:
George Otieno makes an interesting point -- men who
are able to rediscover their sexuality through Viagra
(sometimes after many years of involuntary
abstinence) might indeed be a group needing special
advice on safe sex, and safe choice of sexual
partners, in the era of HIV. Where will they get this
advice?
However, I think an even bigger danger is the spread of potentially dangerous priapism -- even sometimes leading to gangrene if not treated appropriately. So far I don't think there are very good data available -- the clinical trials were done on men with genuine physiological impotence but Viagra is now being used much more widely, and not always under adequate medical supervision. So perhaps this serious complication is more common in men who do NOT have the medical indications for Viagra use (e.g. genuine impotence) but who are rather hoping to improve their performance. (Women are intending to use it for this as well!) I have heard anecdotally that as many as 7% of men in the general population who use it have had this problem, which in extreme cases requires surgical intervention. This seems to suggest that Viagra should not be used recreationally! It has the potential for being a dangerous drug in other ways than its potential contribution to the spread of HIV.
Any urologists out there like to comment?
According to my humble opinion this "discussion" on
the possible inter-relationship between Viagra and
the possible spread of HIV infection, belongs to the
humorous newspaper "Punch".
Did you consider the price of Viagra?
(One tablet is about 10 USD!) How can a poor fellow in a
developing country, - where the possibility of HIV
infection is the highest, - afford such a nice sum of
money for a single tablet of Viagra? In the
developed,- so-called western,- world
people already know the danger of a possible
infection.
While I agree that focusing on VIAGRA and HIV is probably not a major priority now, I would like to report that in, for example, Brazil, sales of the drug are booming, pharmacies cannot keep their stock (at $15 a pill), and before the recent official market opening of VIAGRA sales, a black market (at much higher prices) was flourishing.
"How can a poor fellow in a developing country, -
where the possibility of HIV infection is the highest, -
afford such a nice sum of money for a single tablet of
Viagra?"
One often hears this reasoning, particularly in regard
to African AIDS -- Peter Duesberg's whole analysis of
African AIDS is based on the theory that in Africa,
AIDS is simply another word for diseases of the poor
-- yet study after study in a number of African
countries, which correlate HIV prevalence with
income or education levels, has found that in general
HIV is MOST prevalent among the wealthiest, most
educated persons. (This is apparently, at least in
part, due to the fact that wealthier men can afford
more wives or other sexual partners.) The great
Nigerian musician Fela or the son of Zimbabwe's
Vice-president were hardly poor.
One of the biggest tragedies of African AIDS is that it is decimating the very segment of society, its young educated members, who could have so much to offer their nations. I have been a passive reader of this stream but could not help responding to this piece... I agree that this thread on Viagra and HIV should belong to a humor group, but is it true (in fact) that the possibility of HIV infection is highest in a developing country? How about the obvious fallacy that... " In the developed,- so-called western,- world people already know the danger of a possible infection."
Do people here really already know the danger? How come they still have HIV? "
I have been a passive reader of this stream but could not help re sponding to this piece..."
Me too.
"I agree that this thread on Viagra and HIV should belong to a humor group, but is it true (in fact) that the possibility of HIV infection is highest in a developing country? How about the obvious fallacy that..."
I don't see anything humorous about it however. We now have a new set of problems and a new population set to be concerned with. Viagra surely has it's issues.
"In the developed,- so-called western,- world people already know the danger of a possible infection."
Do you mean to say that people in poor countries do not know the danger of possible HIV infection? Are you update on the results of some recent surveys in the USA? Among which segment of the population is the rate of infection rising fastest?
I hope your views do not reflect the views of the WHO. May I make an addition and a suggestion: US$15 (cost of ONE Viagra pill) is equivalent to one-month's unskilled labour wages in many developing countries (26 days' wages in India for example). So Dr. ...is quite right: the poor can't afford it. So if there is any connection between Viagra and HIV/AIDS, it would affect the rich and elite. That is the price the rich have to pay in their search for stiffness! Probably poor has too much stiffness, that's why they keep on producing children (new right's perennial complaint about population explosion: it's mainly due to the poor can't stop enjoying themselves). At last poor have found something to 'boast' about (Malthus, Ehlrichs and Kings of this world, are you listening?).
Instead of spending all that money for stiffness they should buy more cars (especially BMWs) which for the rich (those who are lacking stiffness) are as exciting, sexy and satisfying. In this case we do not need health educators and public health specialists, but we need more BMW car salespersons and advertisers.
The Workshop:
The workshop started with a plenary, where Tom presented the
PSBH process. This was to enable those attending the workshop
for the first time (there were three new participants who came to
the workshop) to be able to learn what PSBH is all about. It was
also intended to fresh the memories of "old" participants on the
concept. Tom's presentation was followed by a brief run of PSBH
in Zambia (where we have come from, where we are, and where
we are going). This was present by Dick. Norah also gave a brief
report on CBH activities in Zambia.
The second session of the workshop involved all participants. Each participants gave a brief progress report on their project. Questions, clarifications and discussions were allowed after each report. The purpose of this session is to enable participants to listen to the progress or the lack of it made on each project, thus affording them an opportunity to ask questions and seek advice and clarification on which course of action to take after the workshop. This type of discussion also challenges those who are moving slowly to work hard on their project.
After the plenary session, participants were divided into two groups. In the group work, participants went through their projects gain discusses them in detail, drawing on the experience of other participants and facilitators. The "new" participants were assisted to come up with the Problem Statement. The intention was that after the group work, the "old" participants would know exactly where they ought to take their project with a view to consolidating the work already done. The "new" participants were to be helped to reach Good Question stages. After the two group work sessions, each participants had drawn up a Future Plans Activity Report, including the new participant. It was agreed that the Kitwe based Facilitators will work closely with our two participants to help them draw up an action plan. The participants from Kabwe, will be assisted by one of the participants from there.
All in all, the workshop was a success despite the small number of participants. Below is a brief report on each of the projects presented at the workshop:
Statement Problem: Prevalence of Skin Conditions among children under 10 years in Lusaka's Kamanga Compound.
Muyamwa started the project by recruiting 5 members to help him carry out his project. At the moment he has only three members on his team. The other two could not continue due to other commitments. A clinic has been established at Kamanga Primary School. One of the classrooms is being used as a clinic. The project has been received well by the school authorities and Muyamwa and his colleagues have been able to carry out the activities without any problems.
When he started the project in October 1997, 125 pupil were identified to have skin conditions, mostly fungal . 89 of these have been successfully treated and given health education. 13 out of the 89 treated were followed up in their homes and further health education given to the families.
During the project implementation, children found with severe skin infection were referred to government clinics for special attention. With the funds from FBH, Muyamwa was able to have educational materials printed in order to have an effective means of communication with the community
Out of the 89 children treated for skin conditions, 40 showed signs of complete recovery. 20 showed signs of improvements, 4 had reinfection after recovery, 21 could not be assessed because they were absent. The impact on the community of Kamanga is great as the community is now aware of the effects of skin problems which previously they never cared about.
Muyamwa plans to start an hygiene club at the school and introduce an award to the deserving pupil at the end of the year. He will also continue with the existing project so that the remaining children of those targeted can be reached. With assistance from FBH Muyamwa hopes to work closely with pharmaceutical companies to get them involved in this community project.
Edith has been working with the Clinic staff at Nkwazi Clinic to get the project going. Lectures on Paraffin Poisoning have been conducted at all children's clinic to the mothers. Teachers and older school children have been included in these lectures. For her future plans, Edith intends to hold a one day seminar with the community leaders in Nkwazi. She intends to seek assistance from Indeni Petroleum Refinery under their community assistance programme. She hopes to have some pamphlets printed to distribute to schools, hospitals, etc on the dangers of paraffin poisoning. She will work hand in hand with Joshua Siame as he is also doing the same project based in Lusaka.
George has not been able to do much on his project, mainly because of some problems at work. With encouragement from the Facilitators and fellow participants, he will re-visit his project site and start working on his project.
Archibald has not been able to begin his project in Lusaka because he was temporarily transferred to Livingstone. While in Livingstone, he was working with the Interdenominational Health Care committee, to whom he impaired his PSBH skill and was very happy of the response by the committee. He is due back in Lusaka by August, when he will start on his original project.
Nelson has been working on this project since 1996. The project has expanded from the 2 villages he started with to almost 15 villages now. The hospital authorities have been greatly impressed with the response of the villagers to the PSBH concept and are using this method to tackle other health problems in the area. Because of this Nelson has been put in charge of the Malaria Control Task Force in the District. Because the villagers now understand the causes of Malaria and how it can be prevented, more and more are now using treated mosquito nets and preventive measure. Educational talks, clearing of surrounding and filling up of potholes have continued in the villages.
The training of care givers in Makululu compound was undertaken with the assistance from DHF, Kabwe DHMT, Catholic Church and other well wishers. The training has helped with the work in the community of the HIV/AIDS, TB and other chronically ill patients. The community has appreciated the work done by the care givers. Patrick has since been sent to Luanshya for further training. His project has continued under the supervision of Ms Kelly Chanika, who also attended the workshop in Lusaka. It is hoped that Kelly will also develop PSHB skills in order to continue where Patrick has left off.
Millington and John were attending the PSBH workshop for the first time. Dick had to take them through the process in order fro them to understand what DHF/FBH does. At the end of the workshop, they had a statement problem and good questions done. It was agreed that Dick will continue to work with them on their proposed project and help them come up with a proposal which will be presented to the Facilitators' Meeting for consideration. It was also agreed they be invited to the next workshop at the end of the year.
The Unit has been established at Kitwe Central Hospital. With the donation of a computer system by DHF to the project, Andrew is now working on making the any HIV/AIDS information picked from the Internet available to other medical staff. The Information Unit is becoming very popular at the hospital. For his future plans, Andrew has on the drawing board, to conduct a survey in six villages around Mnolo Health Centre in Chief Kapatamoyo's area in Chipata. He is also very interested in working with Millington and John to support research related to the impact of the environment on the health of the people in the Copperbelt.
The Pharmacy and Poisons Board has said the controversial impotence tablet-Viagra- is illegal and warned of serious consequences against anyone found importing it. In a statement released in Lusaka yesterday chairman of the Board Caesar Mudondo said no application has been made for registration of the drug and therefore it was illegal for anyone to bring it into Zambia.
Reacting to the recent debate on viagra tablets, Mr Mudondo warned the public not to express undue excitement as the drug had adverse reactions some of which had resulted in death. Anyone wishing to import the drug should lodge an application for registration but he said such a request will be treated like any other for a new drug.
Any importation of viagra made before registration is effected is illegal, and the Pharmacy & Poisons board will take appropriate action against offenders. The public must be advised that several serious adverse reactions which may or may not be directly caused by viagra tablets have been reported in countries where the drug has been in use for some time, Mr. Madondo said.
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4) SEND THIS FORM (OR A COPY) AND YOUR LETTERS TO THE FOLLOWING ADDRESS:
Zambia Health Information Digest
Medical Library
University of Zambia, School of Medicine
Tel: 01-250801
Fax: 01-250753
P.O. Box 50110
Lusaka, Zambia
medlib@unza.zm
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Last updated December 14, 1998