Monday, November 20, 2017

Tunisia Obtains Observer Status Of West African Bloc



TUNIS, NOV.  20 (XINHUA) -- Tunisia has just obtained observer status in the Economic Community of West African States (ECOWAS), Tunisian Foreign Minister Khemais Jhinaoui told reporters here on Monday.

Jhinaoui also announced the signing of an agreement protocol with the West African intergovernmental organization to put in place an economic roadmap between Tunisia and this African body.

The protocol requires the implementation of an action plan that defines the sectors involved in this multilateral economic partnership, including agriculture, trade and development.

"For the moment, Tunisia will take part, as an observer, in the next meeting of this community scheduled for November in Togo," said Jhinaoui.

Cooperation between Tunisia and the organization will be crowned by the creation of a free trade zone between Tunisia and ECOWAS member states, the minister said.

Currently, Tunisia's trade with these countries accounts for only 1 percent of its total trade, according to Tunisian Minister of Commerce Omar Behia. The rate is aimed to rise to 10 percent.

"Bringing together 15 countries, the Economic Community of West African Countries guarantees the transportation of goods and the free movement of people between member states," said Marcel De Souza, president of the ECOWAS Commission.

He noted the continental organization includes eight central banks, saying one of his ambitions is to create a single currency by 2020.

Bounty Offered For Beheadings Of Bollywood Director, Actress

Members of India's Rajput community shout slogans as they protest against the release of Bollywood film "Padmavati" in Mumbai, India, Monday, Nov. 20, 2017. The film has been in trouble since the beginning of the year, with fringe groups in the western state of Rajasthan attacking the film's set, threatening to burn down theaters that show it and even physically attacking the director in January. A member of India's Hindu nationalist ruling party has offered a 100 million rupee ($1.5 million) reward to anyone who beheads the lead actress and the director of the yet-to-be released film over its alleged handling of the relationship between a Hindu queen and a Muslim ruler.



NEW DELHI (AP) — A member of India's Hindu nationalist ruling party offered 100 million rupees ($1.5 million) to anyone who beheads the lead actress and the director of an unreleased Bollywood film "Padmavati" rumored to depict a relationship between a Hindu queen and a Muslim ruler.

Suraj Pal Amu, a Bharatiya Janata Party leader from the northern state of Haryana, offered the bounty against actress Deepika Padukone and filmmaker Sanjay Leela Bhansali on Sunday. The film's producers postponed the release of the film, which was set to be in theaters Dec. 1, and Amu was reported by local media to have said at a public rally that the film would not be allowed to be released at all.

"Padmavati" is based on a 16th century Sufi epic poem, "Padmavat," in which a brave and beautiful Rajput queen chose to kill herself rather than be captured by the Muslim sultan of Delhi, Allaudin Khilji. Over centuries of its retelling, the epic has come to be seen as history, despite little evidence.

Padukone plays Padmini, the legendary queen who committed "jauhar," the medieval Rajput practice in which female royals walked into funeral fires to embrace death over the dishonor of being taken captive.

"Padmavati" has been in trouble since the beginning of the year, with fringe groups in the western state of Rajasthan attacking the film's set, threatening to burn down theaters that show it and even physically attacking Bhansali in January.

Most of the anger appears to stem from allegations that Bhansali filmed a romantic dream sequence between the protagonists, which Bhansali has denied. Earlier this month, the head of the Rajput Karni Sena in Rajasthan said Padukone should have her nose cut — a symbol of public humiliation — for being part of a film that allegedly insulted the famed queen.

India's 1.3 billion-strong democracy is the largest in the world and has made great economic strides, but its politics are held hostage by a complex mix of religion and caste. Books and movies have been banned or received threats of violence because they either offend one religious or caste group, or are deemed offensive to Indian culture in general.

Hollywood movies are routinely scrubbed of sex scenes, and India's film censor board rejected "Fifty Shades of Grey." ''The Da Vinci Code" was banned in Goa state, which has a large Christian population.

In 2014, the publishing house Penguin India pulled from shelves and destroyed all copies of American historian Wendy Doniger's "The Hindus: An Alternative History" after a Hindu right-wing group protested, mainly because they said the book described Hindu mythological texts as fictional.

Salman Rushdie's "The Satanic Verses" has been banned since 1998, since many Muslims consider it blasphemous. The Indian-born Rushdie was forced to cancel a 2012 appearance at the Jaipur Literary Festival amid protests and threats by prominent Muslim clerics.

China's Deep Ties To Zimbabwe Could Grow After Mugabe Era

Zimbabwe's President Robert Mugabe the way during a welcome ceremony outside the Great Hall of the People in Beijing, China. Under Robert Mugabe’s decades-long rule over Zimbabwe, China grew into one of its biggest investors, trading partners and diplomatic allies. Now, as the African nation appears on the verge of its first transition of power since independence, Beijing is poised to be among the biggest winners.



HONG KONG (AP) — Under Robert Mugabe's decades-long rule over Zimbabwe, China grew into one of the African nation's biggest investors, trading partners and diplomatic allies. Now, as Zimbabwe appears on the verge of its first transition of power since independence, Beijing is poised to be among the biggest winners.

A look at the increasingly close relationship between the two countries:

THE BACK STORY


Mugabe began drawing closer to China's communist leaders under a "Look East" policy when Western countries imposed sanctions on Zimbabwe in 2001 over land seizures and human rights concerns. "We have turned East, where the sun rises, and given our backs to the West, where the sun sets," he famously said.

Mugabe has made frequent visits to Beijing, and sent his daughter Bona to university in Hong Kong. China, meanwhile, has vetoed U.N. Security Council sanctions on Zimbabwe.

Both sides portray the relationship as one between "all-weather friends." But "behind the scenes, things are a little bit different," said Derek Matyszak, a Harare-based senior researcher at the Institute for Security Studies.

"Relations between China and Mugabe have been quite fractious over the past year and a half, and the current situation is going to make things worse," he said.

China is unhappy about Mugabe's mismanagement of Zimbabwe's economy and is believed to favor as his successor, Emmerson Mnangagwa, who's seen as more of an "economic pragmatist," Matyszak said.

Mnangagwa was elected Sunday as the new leader of Zimbabwe's ruling party and is positioned to take over as the country's leader.

MILITARY LINKS
Zimbabwe's army commander, Gen. Constantino Chiwenga, visited Beijing in early November, around the same time Mnangagwa disappeared. The Chinese Foreign Ministry called it a "normal military exchange," but the timing raised suspicions that it was anything but.

The countries' military links date back to the 1960s, when China helped train and supply guerrilla fighters from the Zanu's military wing in the fight for liberation. Mnangagwa, 75, was part of that effort — he received military training in China in 1963, soon after he joined the fight against white minority rule in then-Rhodesia.

These days, China is a key supplier of military hardware to Zimbabwe. Major sales in recent years include a radar system, jet trainers and fighters, military vehicles and AK-47 assault rifles.

A Chinese company built the National Defense College in Harare, which opened in 2014 and was financed with an interest-free $98 million loan from China. The college, the biggest of its kind in the country, trains soldiers, intelligence operatives and police from Zimbabwe and other Southern African countries.

"China, of course, wants Zimbabwe to maintain a peaceful and stable political environment," said Wang Xinsong, a longtime observer of China-Zimbabwe relations at Beijing Normal University. "China's best interest lies in ensuring a peaceful and smooth transfer of power without major turmoil."

ECONOMIC WOES

Once known as the "breadbasket of Africa," Zimbabwe's decline accelerated with the seizure of white-owned farms, sending the economy into a tailspin with skyrocketing inflation and widespread unemployment and poverty.

The lack of a clear succession plan for the 93-year-old Mugabe as well as an industrial nationalization plan have contributed to political uncertainty and spooked overseas investors. Zimbabwe's foreign direct investment fell for a second straight year in 2016, slumping by a quarter to $319 million, according to the latest U.N. World Investment Report.

Analysts believe one major reason Mnangagwa is popular with China is that he is seen as more investor-friendly than Mugabe.

"Of course, we must know that the investment can only go where it gets a return," Mnangagwa said in an interview with state-run China Central Television during a visit to Beijing in 2015. "So we must make sure we create an environment where investors are happy to put their money because they will have a return."

Chinese investors are likely holding off while they wait for a resolution, experts said.

"Chinese businessmen will become more prudent," said Zhang Chun, an expert in African studies at the Shanghai Institute of Foreign Studies. "For those that are prepared to make an investment there, they will delay their projects."

DIAMOND DEALS

A big source of tension between Beijing and Harare was Mugabe's abrupt move to nationalize Zimbabwe's diamond mines.

Two Chinese companies, Anjin Investments and Jinan Mining, had partnered with the military and become big players in the Marange diamond field in Zimbabwe's east.

Mugabe, however, moved last year to revoke licenses from the Chinese and other foreign mining companies and consolidate all operations into a single company half-owned by Zimbabwe's government. He had apparently become alarmed that the government was missing out on revenue, blaming private companies after only $2 billion of an anticipated $15 billion had flown into government coffers since the field was discovered in 2006.

The Institute for Security Studies' Matyszak speculated that Mnangagwa could reverse that move, winning favor with both the military and China in the process.

Chinese tobacco company Tianze, meanwhile, has given interest-free loans and training to farmers, many of whom work on land seized from white farmers, to help beef up production and help fill cigarette demand back home.

The Beijing Automotive Group teamed up this year with two local partners in a joint venture, Beiqi Zimbabwe, selling Grand Tiger pickup trucks assembled from kits to compete with pricier imports.

HARD ASSETS

China has helped build and pay for some big-budget infrastructure projects in Zimbabwe, including $46 million to fund the construction of the country's new parliament building in Harare last year.

Chinese state-owned Sinohydro is building $2 billion worth of expansion projects at Zimbabwe's two main, aging power stations to help deal with chronic electricity shortages. Chinese companies have also built a $150 million expansion of Victoria Falls International Airport and upgraded Zimbabwe's busiest highway.

Other deals announced during a visit by Chinese President Xi Jinping in 2015 included building a pharmaceutical warehouse, expanding the national fiber optic broadband network and supply wildlife  monitoring gear.

SOFT POWER

China and Zimbabwe have been growing closer in other ways too, although results have been uneven.

In 2015, Zimbabwe sold China 35 elephants that were moved to wildlife parks in Shanghai, Beijing and Hanghzhou. But animal conservation groups raised concerns about the plan over fears that the animals would be split up from their herds and end up living under poor conditions.

China also has an image problem among many ordinary Zimbabweans, who see it mainly as a supplier of cheap but shoddy products like shoes and kettles that have been labeled with derogatory names for their famously short-lived lifespans.

The Mugabe family has been involved in a legal dispute over a multimillion-dollar Hong Kong property, and made headlines there in 2009 when Robert Mugabe's wife, Grace, allegedly assaulted a photographer during a shopping trip. She left the specially administered Chinese city without being charged.

Associated Press writer Yi-ling Liu in Hong Kong and researcher Yu Bing in Beijing contributed to this report.

U.S. Charges Two With Bribing African Officials For China Energy Firm

Cheigh Gadio Image Via UNSDSN




WASHINGTON (REUTERS) - The United States has charged a former Senegalese foreign minister and a Hong Kong man with bribing high-level officials in Chad and Uganda in exchange for contracts for a Chinese oil and gas company, the U.S. Justice Department said on Monday.

Chi Ping Patrick Ho, 68, of Hong Kong, and Cheikh Gadio, 61, were charged with violating the Foreign Corrupt Practices Act, international money laundering and conspiracy, the department said in a statement.


It said Gadio, a former foreign minister of Senegal, was arrested in New York on Friday. It added that Ho, who heads a non-governmental organisation based in Hong Kong and Virginia, was arrested on Saturday.

No one could be reached at the embassies of Chad and Uganda in Washington late on Monday. The missions did not immediately respond to emails requesting comment.

The Justice Department did not name the Chinese company.

“Wiring almost a million dollars through New York’s banking system in furtherance of their corrupt schemes, the defendants allegedly sought to generate business through bribes paid to the president of Chad and the Ugandan foreign minister,” Joon Kim, acting U.S. attorney for the Southern District of New York, was quoted as saying in the statement.

Idriss Deby has been Chad’s president since 1990. Ugandan Foreign Minister Sam Kutesa served as the president of the U.N. General Assembly in 2014 and 2015.

Ho’s attorney, Ed Kim, of Krieger Kim & Lewin LLP, declined to comment to Reuters. Bob Baum of Federal Defenders, who represented Gadio for the bail argument, did not immediately respond to a request for comment.

Ho was ordered detained after appearing in court on Monday, the Justice Department statement said. It said Gadio appeared before a judge on Saturday, but it did not say if he was detained.

The Justice Department said a $2 million (£1.51 million) bribe was paid to Chad’s president, who then provided the company with an opportunity to obtain oil rights in Chad without international competition.

The department said in the statement that Gadio was the go-between and was paid $400,000 by Ho via wire transfers through New York.

The Justice Department accused Ho of being involved with bribes and promises of future benefits to Uganda’s foreign minister in exchange for help in obtaining business advantages for the Chinese company.

Ho is the secretary general of China Energy Fund Committee, which describes itself on its website as “a think-tank registered and anchored in Hong Kong, devoted to public diplomacy, with special emphasis on energy and culture.” The organisation did not immediately respond to an email requesting comment.


Reporting by Mohammad Zargham and Eric Beech; Editing by Peter Cooney

US To Contribute $45.5m To Rehabilitation Efforts In North-East

John Sullivan Image Via This Day Newspapers




ABUJA, NIGERIA (THIS DAY) -- The United States Government has said it will contribute an additional $45.5 million to rehabilitation efforts in the North-east.

US Deputy Secretary of State, John Sullivan, said this at the Nigeria-U.S. Bi-National Commission (BNC) meeting in Abuja on Monday.

Mr. Sullivan said the support would help those who had been affected by violence in the North-east to rebuild their lives.

“We are encouraged by Nigeria’s recent steps to establish a North-east Development Commission which could enable many of those displaced by conflicts restart their lives.

“I am proud to announce that the United States, through our colleagues at USAID, will contribute an additional $45.5 million to support stabilisation and early recovery efforts to help those who have been affected by violence in the northeast to rebuild their lives.’’

He, however, urged the government to sustain a comprehensive approach to restoring peace, security and development in the northeast.

Sullivan called for enhanced cooperation between government, Civil Society Organisations (CSOs) and community leaders to “create a doable, socio-economic and political infrastructure to support lasting peace and development.

“That must include transparent and credible investigation of human rights violations and mechanisms to hold those found guilty accountable for their actions.

“This is essential to deepening the people’s trust of government, strengthening security efforts in the North-east and approving the United States ability to partner with Nigeria.”

He further called on government to enhance its efforts by ensuring an all-inclusive economic growth and reiterated his government’s commitment to Nigeria’s economic success.

According to him, the US will inaugurate a commercial and investment dialogue to enhance economic ties between both countries.

Sullivan said that the US Government, through its Power Africa initiative, would also help support the federal government’s efforts at improving electricity access to citizens in the country.
“Another key aspect of our shared prosperity is having the energy resources that are needed to fuel growth.

“I am pleased to announce today a 1.3 million-dollar project to address the shortage of gas available for gas fire power plants under the Power Africa initiative through the Department of State’s Power Sector programme.”

He advised the federal government to build on the successes recorded in the 2015 general elections ahead of the 2019 elections and also added that the US would further its technical assistance and support.

“Free, fair and peaceful 2019 elections at both the federal and state levels are fundamental to our continued partnership.”

Sullivan said that the US would continue to work “closely with the government of Nigeria on repatriating stolen assets to the people of Nigeria” to support the fight against corruption.
He added that the US would further support Nigeria in other development programmes to foster progress in the education and health sectors, including improved service delivery.

The Minister of Foreign Affairs, Geoffrey Onyeama said t the federal government had approved the establishment of the North-east Development Commission as part of measures to sustain peace and development in the country.

Onyeama, according to the News Agency of Nigeria (NAN) recalled that noteworthy achievements had also been recorded since the inception of the commission in 2010.

“The achievements recorded under the platform of this BNC since its inception in April 2010, covers several areas such as security, aviation, trade and investment, economic development, good governance, and power among others.

He also said that the Bi-National Commission meeting would focus on security cooperation, economic growth and shared prosperity.

Saturday, November 18, 2017

Tax Filers In Most States Claim Deduction Targeted By GOP

House Speaker Paul Ryan of Wis., joined by House Republicans, speaks to the media following a vote on tax reform, on Capitol Hill in Washington. A popular deduction targeted in the GOP’s overhaul of the tax code is used by more than a quarter of all filers in a majority of states, including many led by Republicans where some residents eventually could see their federal tax bills rise.



ATLANTA, GEORGIA (AP) — A popular deduction targeted in the GOP's overhaul of the tax code is used by more than a quarter of all filers in a majority of states, including many led by Republicans where some residents eventually could see their federal tax bills rise.

The exact effect in every state isn't known, in part because of differences in the Senate and House versions of the bill. But the change to the deduction for state and local taxes could alter the bottom lines for millions of taxpayers who itemize.

Residents in high-tax, Democratic-led states appear to be the hardest hit. But some filers also could be left paying more in traditional Republican states, such as Georgia and Utah where about a third of taxpayers claim the deduction.

"It's a bad deal for middle class families and for most Georgians," said Georgia state Rep. Bob Trammell, leader of the House Democrats. He said Republicans are eliminating the state and local deduction to help pay for tax cuts for businesses and the wealthy.

How many winners and losers are in each state depends in large part on another aspect of the Republican tax overhaul that would nearly double the standard deduction — to about $12,000 for individuals and about $24,000 for married couples.

Republicans say that provision would be a net benefit for most tax filers. The Tax Policy Center, run by the Urban Institute and Brookings Institution, has estimated that the number of people itemizing deductions would drop by three-quarters. Some of those taxpayers could get a larger deduction under the Republican plan, even though they no longer could claim a break for state and local taxes.

"Based on what I have seen, it might actually help some Georgians" to replace the state-and-local tax break with a higher standard deduction, said Georgia state Rep. Terry England, the Republican chairman of the House Appropriations Committee.

Yet estimates by the Tax Policy Center and a nonpartisan congressional analysis say some taxpayers eventually will end up owing more in federal taxes under the GOP plans. The left-leaning Institute on Taxation and Economic Policy said changes to the state and local tax deduction under the House bill would contribute to one of every five taxpayers in the hardest hit states getting a higher tax bill. While most of those states are led by Democrats, Republican-led Georgia and Utah, and the swing state of Virginia were among them.

Democratic lawmakers said that any initial tax relief felt by the middle class or working-class families will eventually disappear. In Georgia, for example, an estimated 9 percent of filers would pay higher taxes in 2018, rising to 22 percent by 2027, according to an analysis by the Institute on Taxation and Economic Policy.

The state and local tax deduction is just one of many provisions targeted for change under legislation that passed the House earlier in the week and is pending in the Senate. The House version would repeal the deduction for income and sales taxes while capping the property tax deduction at $10,000. The Senate bill would end deductions for all state and local taxes.

Most tax filers currently take the standard federal deduction of $6,300 per individual or $12,600 for married couples. But some reap larger tax breaks by itemizing deductions for state and local taxes, medical expenses, charitable contributions and interest paid on home mortgages.

The state and local tax break is the largest of those. About 44 million taxpayers claimed deductions totaling around $550 billion for state and local taxes paid in 2015, according to the most recent IRS data.

The top 10 states with the highest average state and local tax deductions all voted for Democrat Hillary Clinton in last year's election. New York led the way with an average state and local tax deduction of more than $22,000, followed by Connecticut, California, New Jersey and Massachusetts.

But when analyzed by the percentage of taxpayers claiming the deduction, several states won by Trump rank in the top third nationally. In reliably Republican Utah, 35 percent of taxpayers claimed the deduction for state and local taxes. That figure was 33 percent in Georgia and 31 percent in Wisconsin. Thirty-five states had at least one-quarter of their taxpayers claim the deduction.

Because of its widespread effect, debate over curtailing the deduction already is creeping into competitive 2018 elections. Democratic U.S. Sen. Tammy Baldwin of Wisconsin has warned that repealing the deduction could lead to a tax increase for many state residents.

The left-leaning Wisconsin Budget Project has estimated that the Senate plan overall eventually would leave nearly 300,000 Wisconsin taxpayers with higher federal income taxes. Baldwin said the plan will disproportionally benefit corporations and the wealthiest.

"That's not right and it's not fair," she said during a news conference Friday in Milwaukee. One of her Republican challengers, state Sen. Leah Vukmir, has signed a letter encouraging the tax repeal. Republican Gov. Scott Walker, a tax overhaul supporter who is seeking re-election, has been criticized by the liberal advocacy group One Wisconsin Now. The group says repealing the deduction would have "the net effect of a massive property tax increase for Wisconsin homeowners."

Utah state Sen. Howard Stephenson is a strong supporter of repealing the state and local tax deduction, even though a comparatively high percentage of residents there claim it. Stephenson, a Republican who is president of the Utah Taxpayers Association, said he believes the deduction generally favors high-tax states to the detriment of states with a lower tax burden, such as his own.

"We don't like paying for the excesses in other states," he said.

Lieb reported from Jefferson City, Missouri, and Cassidy from Atlanta.

Associated Press writer Scott Bauer in Madison, Wisconsin, contributed to this report.

Follow David A. Lieb at: http://twitter.com/DavidALieb and Christina A. Cassidy at https://twitter.com/AP_Christina

Friday, November 17, 2017

Italy Buries 26 Nigerian Women - Most Without A Name

BY TRISHA THOMAS







SALERNO, ITALY (AP) — More than two dozen young Nigerian women who drowned during a migrant crossing from Libya were honored Friday with an interfaith funeral, closing out a gruesome new chapter in the years-long tragedy of desperate migrants trying to reach Europe and dying along the way.

To date, only two of the 26 women whose bodies were recovered Nov. 3 by Spanish rescue ships have been identified: Marian Shaka, a Muslim, and Osato Osara, a Christian.

Prosecutors are working to contact relatives of the others, using phone numbers the women had hidden in their clothes before setting off from Libya's lawless shores. So far, investigators have reached family members of three of them. Relatives were able to provide general descriptions of their girls, and confirmed they hadn't heard from them.

Autopsies showed all but one drowned. The other had internal bleeding from a ruptured liver as a result of blunt trauma before falling in the water. None bore signs of recent physical or sexual abuse, prosecutors said in a statement Friday. Two of the women were pregnant.

Overall, 100 people were believed to have drowned in the crossing. The other bodies were lost at sea. They had all set off aboard a blue rubber raft. Sixty-four survived.

On Friday, 26 wooden coffins were laid out in a circle in the middle of Salerno's cemetery for the interfaith funeral ceremony. There was no indication the Nigerian Embassy or Consulate sent a representative.

Salerno Archbishop Luigi Moretti told the crowd that the women "lost their lives as they were seeking freedom and a better life."

"And we give the last farewell not only to the 26 girls but also to two lives that these girls were carrying in their wombs," he added.

Imam Abderrhmane Es Sbaa offered a prayer before he and Moretti blessed the coffins, with Moretti sprinkling holy water on them. The crowd silently passed by, placing white roses on each one.

Overall this year, nearly 168,000 migrants have arrived in Italy, a 32-percent decline over last year thanks to a deal Italy struck with the Libyan government and its militias to curb the exodus. The U.N. refugee agency estimates around 3,000 have died trying, though the number is likely much higher given the unknown number of shipwrecks that are never reported.

It's not clear whether the 26 women were part of the huge human trafficking business that brings thousands of Nigerian women to Italy every year to work as prostitutes.

The past three years has seen a 600-percent increase in potential sex trafficking victims arriving in Italy, most of them from Nigeria, according to the International Organization for Migrants. IOM statistics show 1,454 girls arrived from Nigeria in 2014 and the number soared to 11,009 in 2016.

Alessandra Galatro, who works to help young Nigerian women escape prostitution, came to the funeral with a group of Nigerian girls who stood at a distance during the ceremony then shyly approached the coffins at the end, gently touching them one by one.

"It is not easy for them because they have all made that crossing, that journey," Galatro said. "The cruelty that these women faced in Libya, they all experienced."

Thursday, November 16, 2017

Monkeypox On The Rise: How Worried Should We Be?





A woman shows symptoms of monkeypox in 2008 in the Democratic Republic of Congo.Jeff Hutchens/Getty Images




AFRICA (NATIONAL PUBLIC RADIO) -- Earlier this month, the Washington Post ran a big, feature about a seemingly scary disease, called monkeypox.

"It kills up to 1 in 10 of its victims, similar to pneumonic plague, and is particularly dangerous in children," the story observes at the beginning.

Plus, the virus appears to be on rise.

"Since 1970, 10 countries in Africa have had at least one recorded human case of monkeypox," the story says. A map shows the disease popping up across countries in West and Central Africa, including the Congo Republic, where the story takes place. The country is fighting an outbreak with 88 cases and six deaths, the World Health Organization says.

The story chronicles a thrilling hunt to find the source of monkeypox: Is it a giant pouched rat? An African brush-tailed porcupine?

And it put monkeypox at the forefront of national media. Even Fox News picked up on the idea and ran a segment entitled: "Monkeypox & Black Death Plague Resurface," read a headline for a Tucker Carlson segment. "It could reach this country before we know it's coming," Carlson said.

There's no question monkeypox can be a serious disease. It causes a fever, and a rash, which can turn into painful, fluid-filled blisters on the face, hands and feet.

But here at Goats and Soda, we wanted to know more. Where on Earth does this virus come from? And how dangerous is it compared to other threats, like Ebola or H7N9 bird flu?

To get the lowdown, we talked to two monkeypox experts: Anne Rimoin at the University of California, Los Angeles, who has studied monkeypox in the Democratic Republic of Congo for 15 years; and Jay Hooper at the U.S. Army Medical Research Institute of Infectious Diseases, who is working to develop a better monkeypox vaccine.

Here are some of the questions we asked and some of their surprising answers.

Where does it come from? Monkeys?

No!

"The name is actually a little bit of a misnomer," Rimoin says. Perhaps it should be called "rodentpox" instead.

Yes, monkeys can get monkeypox. But they aren't major carriers. Instead, the virus likely persists in squirrels or another rodent.

How do you catch it?

From an animal bite, scratch or contact with their bodily fluid. Then the virus can spread to other people through coughing and sneezing or contact with pus from the lesions.

"But it doesn't spread very well between people," Hooper says. "It's infection rate is much lower than that of smallpox." In many cases, people don't spread the virus to anyone else.

"There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population," the World Health Organization writes.

Is there likely to be an outbreak in the U.S.?

"There already was!" Hooper says. "But it was quickly contained."

In 2003, monkeypox hitched a ride with a shipment of animals from Ghana to Illinois. Several giant pouched rats and squirrels tested positive for the virus and eventually spread it to prairie dogs, being sold as pets in multiple states in the Midwest, the Centers for Disease Control and Prevention writes.

Forty-seven people caught the disease from the prairie dogs. Everyone recovered. And no one spread the disease to another person.

Is monkeypox a "new" virus?

No. The virus has likely been infecting people for centuries, even millennia, Rimoin says. But for a long time, doctors missed the cases.

Monkeypox is closely related to smallpox. "They are clinically indistinguishable," Rimoin says. "So for centuries, doctors have likely mistaken monkeypox for smallpox."

Then in 1970s, the world was close to eradicating smallpox. Cases plummeted. And doctors in Central Africa started noticing another disease that looked like smallpox but didn't spread as well between people. It was monkeypox.

There are several other virus related to smallpox, including cowpox and camelpox. "I would be more worried about camelpox than monkeypox," Rimion says, "because that's closer on the genetic tree to smallpox."

Is the disease actually a rising threat? Or are just better at detecting it?

A little bit of both, Rimion says.

Back in 2010, Rimoin and her colleagues reported that monkeypox had increased 20-fold in the Democratic Republic of Congo since the 1980s. Incidence rose from less than 1 case per 10,000 people to about 14 cases per 10,000 people.

And the reason for this bump is ironic: The eradication of smallpox.

The smallpox vaccine actually works quite well to protect people against monkeypox. It's about 85 percent effective (although the vaccine does have some safety concerns, Hooper points out. "It's a live virus and cause a deadly infection in people with severely compromised immune systems.").

But after the world eradicated smallpox, countries stopped vaccinating kids. And for those who were vaccinated years earlier, their protection has likely waned over time, Hooper says.

"So now there's this growing population of people who don't have immunity to monkeypox," he says. "And when you do have a outbreak, it's likely to be bigger because less people in the community are protected."

That means small outbreaks in West and Central Africa now have dozens of cases instead of just one or two, Hooper says.

So is monkeypox one of the major viral threats worldwide?

"Nah," Hooper says. "Because the virus doesn't transmit very easily between people. If it did, then it would be top priority."

On average, a person sick with monkeypox spreads the virus to between zero and one person. So outbreaks burn themselves out quickly.

"You have primary cases, in which people get monkeypox from an animal, and they may transmit the disease a few generations — but then that's it," she says. "The outbreaks tend to be self-limiting."

Could that change?

"Oh yes," Hooper says. "Every time, there's an outbreak — and the more people get infected — the more chances monkeypox has to adapt to people," he says.

In other words, the more time the virus spends inside people, the more time it has to evolve. It could possibly figure out how to spread more quickly between people.

So scientists are keeping a close eye on the virus and these small outbreaks.

"We didn't think Ebola spread very easily between people," Hooper adds. "And we were all surprised that health care workers could catch it even though they were wearing protective gear."

"With viruses that spillover from animals, you just never know what's going to happen."

Wednesday, November 15, 2017

Nigerian Woman Wins Appeal Over Refusal Of Refugee Status






Dublin Four Courts Image Via Irish Examiner




DUBLIN, IRELAND (IRISH EXAMINER) -- A woman who claims her husband was shot dead by pro-government supporters in Nigeria some years ago has won her appeal over being refused refugee status.

The three-judge Court of Appeal unanimously ruled the Refugee Appeals Tribunal (RAT) breached the woman's right to fair procedures in how it reached adverse findings about her personal credibility.

She came here some months after her husband's death more than 10 years ago, but did not apply for asylum for another four years.

After being arrested by gardaí over failure to produce identification documents, she sought asylum on grounds of a "well-founded" fear of persecution, as the widow of a leader of an anti-government militia, if returned to Nigeria.

The Office of the Refugee Applications Commissioner refused refugee status and, because of her four-year delay seeking refugee status, she was entitled to a "papers-only" appeal before the RAT, not an oral hearing.

She argued the tribunal was obliged to take particular care as she had no opportunity to respond to concerns in the mind of the tribunal member.

After the High Court dismissed her judicial review proceedings over the RAT's adverse credibility findings, she appealed.

Allowing the appeal, Mr Justice Michael Peart said a number of reasons for the adverse credibility finding were "flawed" because they were based on matters of concern to the tribunal, which the woman was given no opportunity to address and which were "material" to her case and her credibility.

These included the tribunal's failure to consider a newspaper article which, if authentic, provided "powerful evidence" of the correctness of her claim her husband was a leader of an anti-government group who was murdered.

The judge was also concerned the tribunal raised issues about the woman not having produced a marriage certificate when she had not been asked to do so and it had never been suggested she was not married to the murdered man.

He was also concerned questions about the authenticity of a death certificate for the husband were never put to her before the tribunal, in its decision, expressed concerns about that certificate, including it being dated the same date as the killing.

That issue should have been put to the woman before the tribunal decided her account was not credible, he said.

It was "curious" that, until the hearing of this appeal, neither the woman, the ORAC, the RAT, nor any of the lawyers involved in the case appeared to have noticed the death certificate, shown to the court, described the primary cause of death as "haemorrhage/gun shot", he noted.

After the RAT indicated a concern the certificate did not indicate the cause of the haemorrhage and therefore did not corrorobrate the woman's claim he had been shot, solicitors for the woman replied it was asserted the haemorrhage and heart failure stemmed from the shooting and the certificate did not indicate the reasons why those conditions occurred.

The reference to "gun shot" on the certificate was "clearly relevant" to the credibility of the woman's case as it was corroborative of her claim her husband was shot, giving rise to her own well-founded fear of persecution if returned to Nigeria, the judge said.

Because this matter was not referred to in the RAT decision or by the High Court, and was only referred to in submissions in the appeal, the Court of Appeal could not have regard to it.

In all the circumstances, the court would quash the RAT decision due to breach of fair procedures, he ruled.

Tuesday, November 14, 2017

Coup Fears In Zimbabwe As Explosions Rock Harare

A street scene along Robert Mugabe road in Harare. Image: Associated Press




HARARE, ZIMBABWE (ASSOCIATED PRESS) -- At least three explosions were heard in Zimbabwe’s capital early Wednesday and military vehicles were seen in the streets after the army commander threatened to “step in” to calm political tensions over 93-year- old President Robert Mugabe’s possible successor. The ruling party accused the commander of “treasonable conduct.”

The Associated Press saw armed soldiers assaulting passers-by in the early morning hours in Harare, as well as soldiers loading ammunition near a group of four military vehicles. The explosions could be heard near the University of Zimbabwe campus.

Those developments came several hours after The Associated Press on Tuesday saw three armored personnel carriers with several soldiers in a convoy heading toward an army barracks just outside the capital. For the first time, this southern African nation is seeing an open rift between the military and Mugabe, the world’s oldest head of state who has ruled since independence from white minority rule in 1980. The military has been a key pillar of his power.

Mugabe last week fired Vice President Emmerson Mnangagwa and accused him of plotting to take power, including through witchcraft. Mnangagwa, who enjoyed the military’s backing and once was seen as a potential president, fled the country and said he had been threatened. Over 100 senior officials allegedly supporting him have been listed for disciplinary measures by a faction associated with Mugabe’s wife, Grace.

The first lady now appears positioned to replace Mnangagwa as one of the country’s two vice presidents at a special conference of the ruling party in December, leading many in Zimbabwe to suspect that she could succeed her husband. Grace Mugabe is unpopular with some Zimbabweans because of lavish spending as many struggle, and four people accused of booing her at a recent rally were arrested.

On Monday, army commander Constantino Chiwenga issued an unprecedented statement saying purges against senior ruling ZANU-PF party officials, many of whom like Mnangagwa fought for liberation, should end “forthwith.”

“We must remind those behind the current treacherous shenanigans that when it comes to matters of protecting our revolution, the military will not hesitate to step in,” the army commander said. The state-run broadcaster did not report on his statement.

Showing a generational divide, the ruling party’s youth league, aligned with the 52-year-old first lady, on Tuesday criticized the army commander’s comments, saying youth were “ready to die for Mugabe.”

On Tuesday night the ruling party issued a statement accusing the army commander of “treasonable conduct,” saying his comments were “clearly calculated to disturb national peace and stability” and were “meant to incite insurrection.” It was not clear whether the commander still had his post.

State broadcaster Zimbabwe Broadcasting Corporation read out part of the ruling party statement late in the nightly news, which was led by a report on regional tourism.

The army spokesman was not immediately available for comment.

“Yes, given the past two weeks’ political events, it is tempting to speculate that there is a connection between the deployment of military personnel and the comments of the army chief of staff on an ’intervention’ - but there are very real dangers of violence breaking out as a result of rampant and unfounded speculation,” African Defence Review analyst Conway Waddington wrote Tuesday evening, saying there appeared to be no other signs of an “organized coup” and that it could have been an act of intimidation instead.

Mugabe in the past has warned military commanders from interfering in succession politics. “Politics shall always lead the gun, and not the gun politics. Otherwise it will be a coup,” he told supporters in July.

Frustration has been growing in once-prosperous Zimbabwe as the economy collapses under Mugabe. The country was shaken last year by the biggest anti- government protests in a decade, and a once-loyal war veterans association turned on the president, calling him “dictatorial” and blaming him for the economic crisis.

“Mnangagwa was held out by many as the best hope within ZANU-PF for piloting an economic recovery,” analyst Piers Pigou with the International Crisis Group wrote Tuesday.

Now, “Mugabe will have to employ all his guile if he intends to ensure continued accommodation with the armed forces.”

Kola Aluko’s New York Apartment Sold To Mystery Buyer At $36m

THIS DAY
NOVEMBER 15, 2017



Kola Aluko Image Via This Day




NEW YORK (THIS DAY NEWSPAPERS) -- A yet-to-be-identified buyer has paid $36 million for the luxury penthouse at the One57 tower in New York, United States formerly owned by wanted Nigerian oil merchant Kola Aluko, the Cable reports.
Quoting Bloomberg, it reported that the 79th-floor apartment was sold at a foreclosure auction.

The transaction means a $15 million loss on the property. The oil magnate wanted in Nigeria by the Economic and Financial Crimes Commission (EFCC) for fraudulent oil deals estimated at $1.5 billion, bought the apartment in 2014 for $51 million.
Aluko, along with his business partner, Jide Omokore, also has a case to answer in the United States for alleged money laundering charges.

With oil deals closed in Nigeria, Aluko subsequently defaulted on mortgage and tax payments on the property.

The Luxembourg-based Banque Havilland which issued the mortgage on the One57 apartment had initially planned to put the apartment up for auction in July, but foreclosure proceedings were delayed after another one of Kola Aluko’s creditors came forward and claimed the Nigerian oilman owed it about $83 million for gasoline and jet fuel.

The bank attempted to sell the property in September for $39 million but couldn’t get any buyer. So it was put back on the auction block.

The 47-year-old tycoon, linked to former oil minister, Diezani Alison-Madueke, has vanished from the radar since he was declared wanted by both the U.S. authorities and the EFCC.
A Nigerian court tried to freeze Aluko’s assets, including his One57 unit, as part of the alleged scheme to defraud the government of oil sale profits.

But the court could not find Aluko to serve him with papers.

It is believed that he may simply be floating around the world on his 213-foot yacht, the Galactica Star, bought at a cost of $80million, despite strong objections by Alison-Madueke.

Her objection was made known via court papers filed by America’s Justice Department.
In 2015, the yacht was sailing around the Mediterranean. It was spotted in Cancun last year, and may now be berthed in Turkey.

The yacht, apart from the penthouse, has been listed for seizure by the U.S. government, in the case filed in Houston, Texas.

Both Aluko and Omokore were alleged in the case to have paid bribes between 2011 and 2015 to Alison-Madueke who ensured that shell companies owned by the businessmen received billion-dollar contracts to sell Nigeria’s crude oil.

President Muhammadu Buhari cancelled the oil swap arrangement in November 2015, seven months after taking office.

The U.S. Justice Department (DOJ) lawsuit provided more insight into the scale of theft of Nigeria’s oil riches under Alison-Madueke’s watch. The civil lawsuit, brought by DOJ’s Kleptocracy Asset Recovery Initiative, is seeking to recover $144 million in assets.

Kazakhstan Seeks To Help Africa Rise Out Of Poverty





ASTANA (LATIN AMERICAN HERALD TRIBUNE) – Kazakhstan shared on Tuesday in a symposium with representatives of 43 African countries its experience in poverty reduction, in order to help Africa leave behind decades of economic hardship.

“We want to share our lessons and experiences of economic transformation to help African countries achieve economic diversification,” Kazakh Deputy Foreign Minister Yerzhan Ashikbayev said.

Ashikbayev spoke at the South-South Development Exchange symposium organized with the United Nations Development Program (UNDP) under the theme “Economic diversification and industrialization in Africa in the context of the Sustainable Development Goals (SDGs).”

Kazakhstan, declared a “middle income” country by the World Bank, has improved its poverty level from 40 percent in the 1990s to less than 3 percent today.

Ashikbayev recalled that sustainable development is crucial for countries in the African continent which, like Kazakhstan, are rich in natural and human resources.

“We believe that peer learning offers countries special opportunities and serves as a platform to exchange ideas and develop innovative solutions to common complex problems such as poverty and economic inequality,” the Kazakh Deputy Foreign Minister said.

“To support this process and enrich the debates, Kazakhstan is ready to share its own experience and learn from the success stories in Africa,” he added.

A situation that Ashikbayev has compared with that of some African countries, which have not seen their levels of poverty change since the last decade of the 20th century.

UNDP Deputy Resident Representative in Kazakhstan Munkhtuya Altangerel said that South-South cooperation could boost mechanisms such as accountability or transparency.

“It can provide some tangible development dividends: decent jobs, healthier citizens and better social welfare for children and young people,” he added.

Representatives of 43 African governments as well as members of academic centers and other development institutions are participating in the four-day symposium.

The SDGs are a set of objectives adopted by the United Nations that seek, through the adoption of various measures, the eradication of hunger and poverty, the protection of the planet and the reduction of inequalities.

Comboni Missionaries Challenge Reporting On Africa

Pope Francis Poses For A Selfie With A Migrant. Image: AP Via Vatican Radio




SALA MARCONI, ITALY (VATICAN RADIO) -- The theme that the Holy Father, Pope Francis, has chosen for the 2018 World Day of Social Communications relates to what has come to be known as “fake news” namely baseless information. Fake news involves misleading distortion of facts with possible repercussions for innocent individuals or communities. It is in this vein that Italian-based Comboni Missionaries, Tuesday, held a media conference at the Vatican Radio’s Sala Marconi.

Under the title, “L’Africa non √® una fake news” meaning Africa is not about fake news, the Comboni Missionaries assert that the Church cannot afford to remain indifferent in the face of such massive disinformation on Africa.

The media conference was an attempt to challenge and correct the disinformation prevalent in some Western media particularly in the field of migration.

During the conference, the panel of speakers was concerned that public debate on Africa in Italy and Europe is dominated mainly by prejudice and fear often fueled by media campaigns and an ideology that pushes a particular kind of politics. It has become common, they said, for Western media to speak of an 'invasion' of migrants even when facts speak otherwise.

Speaking at the conference, renowned journalist and Comboni Missionary, Fr. Giulio Albanese, who has worked and lived in Africa for many years, decried Italian media’s preoccupation of labeling migrants under the so-called “cronaca nera” effectively criminalising them. Fr. Albanese said citizens in Europe need to hear the other side of the story. They need to take time to listen to stories of migrants who arrive on their soil. He said the truth is that the majority of migrants are compelled to leave their homeland due to injustices and exploitation that sometimes ironically benefit Western economies.

Panelists at the media conference included Fr. Domenico Guarino, a Comboni priest from Palermo, a city in the South of Italy. Fr. Guarino said he has seen migrants arrive in Italy and they were anything but criminals. He said many of them come to Italy traumatised and sometimes as victims of torture experienced on their journey. He criticised a recent agreement between Italy and Libya, which he said abandoned vulnerable migrants to militants who have no regard for human life.

According to Fr. Guarino, the majority of migrants come from countries that have been systematically impoverished by multinationals in cooperation with various predatory African governments. He appealed to Europe not to cloud itself under the veil of fear. Fear, Fr. Guarino said, can be contagious. Nevertheless, if fear is contagious, so too are courage and hope. Sowing seeds of hope is what the Comboni Missionaries are trying to do 150 years after Saint Daniel Comboni founded the Comboni Order with a pastoral apostolate for Africa.

Others who spoke at the media conference were Sr. Gabriella Bottani, a Comboni Missionary Sister who is the coordinator of “Talitha Kum.” Talitha Kum is a Rome-based international network of nuns against human trafficking.

Father Elias Sindjalim a Togolese priest who spent many years in the Democratic Republic of Congo (DRC) explained how different militias in some parts of DRC fuel migration.

Mr. Luciano Ardesi, described as an Africanist and a collaborator of the Comboni magazine, Nigrizia, referred to the expropriation of land in African countries, by multinationals, as a phenomenon not only destroying the environment but also one that is now a cause of migration.

Thus, the first line of solidarity, according to the media conference, is factual information.

Before High-Level Discussions, US Aims To Strengthen Ties To Africa




US Secretary of State Rex Tillerson




WASHINGTON (VOICE OF AMERICA) -- U.S. Secretary of State Rex Tillerson will welcome 37 African foreign ministers to Washington later this week in the largest African foreign policy event to date under President Donald Trump.

The event on November 16 and 17 will include discussions on trade and investment, counterterrorism, and good governance. In addition to the ministerial attendees, African Union Chairperson Moussa Faki Mahamat and other A.U. representatives will attend.

Acting U.S. Assistant Secretary of State for African Affairs Donald Yamamoto told VOA's Africa 54 the goal is to craft policy that goes beyond aid to build mutually beneficial partnerships.

“If you look at the United States and our approach to not just Africa, but in the other regions of the world, it’s a much more multidimensional, very complex approach,” Yamamoto said. “It is not just only humanitarian assistance, but also developing capacity infrastructure, and also we’re looking at capacity building. In other words, we’re looking at how we can have sustainable economic growth.”

Yamamoto said the meeting will focus on preparing for the future. By the year 2100, Africa is projected to be the most-populous continent in the world with 2.2 billion people. About 70 percent of its population is under 30, and this “youth bulge” can either be a blessing or a curse, depending on how the continent prepares.

“What’s the potential for unemployment, and do we have enough job creation to meet those needs?” Yamamoto asked. “A stronger Africa means a stronger America and a stronger world.”

Security, counter-terrorism

Africa unexpectedly came to the forefront of the Trump administration’s foreign policy last month with the killing of four Green Berets in a remote village in Niger. Following the attack, U.S. Sen. Lindsey Graham, R-South Carolina, said, “The war is headed to Africa. It’s beginning to morph. As we suppress the enemy in the Mideast, they are going to move.”

In the near term, the United States will continue to play a lead role in training African partner nations. U.S. forces have trained thousands of African soldiers in the past 10 years. Working with local partners, the United States has helped upgrade security and facilitate coordination across nations to guard against Boko Haram, Islamic State, drug trafficking and other threats, according to Yamamoto.

In the long term, however, security will come from economic growth and prosperity, Yamamoto said. To ensure this, the United States wants to discuss strategies for reducing debt and eliminating barriers to trade within the continent.

“If we break down non-tariff trade barriers and barriers that prevent trade from happening between the countries, then what we are going to see is not only expansion of investments in trade and opportunities, but also economic growth, and that could be the spark, the basis for other trade and development,” he said.

Zimbabwe Party Accuses Army Leader Of Treason

Zimbabwe's Army Commander, Constantino Chiwenga addresses a press conference in Harare. Armored personnel carriers were seen outside the capital a day after the army commander Chiwenga threatened to "step in" to calm political tensions over the president's firing of his deputy.



HARARE, ZIMBABWE (ASSOCIATED PRESS) — The Latest on Zimbabwe's political turmoil (all times local): 8:35 p.m. Zimbabwe's ruling party is accusing the country's army commander of "treasonable conduct" for his threat to have the military step in and calm political turmoil.

The statement issued Tuesday night says the unprecedented comments made a day earlier by army commander Constantino Chiwenga were "clearly calculated to disturb national peace and stability" and were "meant to incite insurrection."

The statement comes hours after The Associated Press saw three tanks with several soldiers in a convoy on a road heading toward an army barracks just outside the capital, Harare. While it is routine for tanks to move along that route, the timing heightens unease in a country that for the first time is seeing an open rift between the military and 93-year-old President Robert Mugabe.

Tensions rose last week after Mugabe fired his deputy Emmerson Mnangagwa, who had the military's support.

5:30 p.m.

Zimbabwe is on edge as armed personnel vehicles are seen outside the capital a day after the army commander threatened to "step in" to calm political tensions over the president's firing of his deputy.

The Associated Press saw three armed personnel vehicles with several soldiers in a convoy on a road heading toward an army barracks just outside the capital, Harare.

While it is routine for armed personnel vehicles to move along that route, Tuesday's timing heightens unease in this country that for the first time is seeing an open rift between the military and 93-year-old President Robert Mugabe.

Mugabe last week fired Vice President Emmerson Mnangagwa and accused him of plotting to take power. Over 100 senior officials allegedly backing Mnangagwa have been listed for disciplinary measures by a faction associated with Mugabe's wife.

Retired US General Says Nuclear Launch Order Can Be Refused

General C. Robert Kehler, far right, USAF (Ret.) former Commander United States Strategic Command, testifies before the Senate Foreign Relations Committee hearing on North Korea on Capitol Hill in Washington, Tuesday, Nov. 14, 2017. Also testifying are Dr. Peter D. Feaver, center, Professor of Political Science and Public Policy Duke University and Brian McKeon, left, former Acting Under Secretary for Policy U.S. Department of Defense.



WASHINGTON (ASSOCIATED PRESS) — A retired Air Force general told the Senate on Tuesday that an order from President Donald Trump or any of his successors to launch nuclear weapons can be refused by the top officer at U.S. Strategic Command if that order is determined to be illegal.

During testimony before the Foreign Relations Committee, retired Gen. Robert Kehler said the U.S. armed forces are obligated to follow legal orders, not illegal ones. Kehler, who served as the head of Strategic Command from January 2011 to November 2013, said the legal principles of military necessity, distinction and proportionality also apply to decisions about nuclear weapons use. The command would control nuclear forces in a war.

Sen. Ben Cardin of Maryland, the committee's top ranking Democrat, asked Kehler if that means Strategic Command can deny the president's order if it fails the test of proportionality and legality. "Yes," Kehler responded, adding such a situation would lead to a "very difficult conversation." It might prompt a president to put a new general in charge to carry out his order, said Brian McKeon, a former acting undersecretary of defense for policy during the Obama administration, who testified alongside Kehler.

The hearing comes as the threat of nuclear attack from North Korea remains a serious concern. Trump's taunting tweets aimed at Pyongyang have sparked concerns primarily among congressional Democrats that he may be inciting a war with North Korea.

But if a president's order to fire nuclear weapons, even pre-emptively, is determined to be sound and legal, there's no one who can stop him. Not the Congress. Not his secretary of defense. And by design, not the military officers who would be duty-bound to execute the order.

As Bruce Blair, a former nuclear missile launch officer and a co-founder of Global Zero, the international movement for the elimination of nuclear weapons, has put it: "The protocol for ordering the use of nuclear weapons endows every president with civilization-ending power." Trump, he wrote in a Washington Post commentary last summer, "has unchecked authority to order a preventive nuclear strike against any nation he wants with a single verbal direction to the Pentagon war room."

Or, as then-Vice President Dick Cheney explained in December 2008, the president "could launch a kind of devastating attack the world's never seen. He doesn't have to check with anybody. He doesn't have to call the Congress. He doesn't have to check with the courts."

And the world has changed even more in the decade since, with North Korea posing a bigger and more immediate nuclear threat than had seemed possible. The nature of the U.S. political world has changed, too, and Trump's opponents — even within his own party — question whether he has too much power over nuclear weapons.

Some aspects of presidential nuclear war-making powers are secret and therefore not well understood by the public. The system is built for fast decision-making, not debate. That's because speed is seen as essential in a crisis with a nuclear peer like Russia. Unlike North Korea, Russia has enough nuclear weapons to destroy the U.S. in minutes.

Russia's long-range missiles could reach the U.S. in about 30 minutes. Submarine-launched missiles fired from nearer U.S. shores might arrive in half that time. Given that some of the U.S. response time would be taken up by administrative steps, the president would have less than 10 minutes to absorb the information, review his options and make his decision, according to a December 2016 report by nuclear arms specialist Amy Woolf of the Congressional Research Service.

A president who decided to launch a nuclear attack — either in retaliation for a nuclear strike or in anticipation of one — would first hold an emergency conference with the defense secretary, the Joint Chiefs of Staff chairman and other advisers. The commander of U.S. Strategic Command, now Air Force Gen. John Hyten, would brief the president on strike options, and the president would make his decision.

The president would communicate his decision and transmit his authorization through a device called the nuclear football, a suitcase carried by a military aide. It's equipped with communication tools and a book with prepared war plans.

If the president decided to order a strike, he would identify himself to military officials at the Pentagon with codes unique to him. These codes are recorded on a card known as the biscuit that is carried by the president at all times. He would then transmit the launch order to the Pentagon and Strategic Command.

Blair, the former missile launch officer, said there is no way to reverse the president's order. And there would be no recalling missiles once launched.

Saturday, November 11, 2017

To Reduce Neonatal Mortality, Nigeria Is Taking A Simple Treatment Nationwide

BY T.R. GOLDMAN


Fatima Yakubu, a Nigerian community health extension worker, holds tubes of chlorhexidine digluconate 7.1 percent gel. Yakubu’s rural primary health care facility is one of about 120 clinics in the central Nigerian state of Kogi that are supported by USAID’s Maternal and Child Survival Program. Image by T.R. Goldman. Nigeria, 2017.




NIGERIA (HEALTH AFFAIRS) -- At the Okene Zonal Hospital in Kogi State, Nigeria, an infant’s tiny face—still flecked with a newborn patina because the boy had been born less than an hour earlier—was barely visible. The baby, wrapped in billows of Ankara cloth, lay on a small mattress inside a slatted metal basket whose graceful curves evoked a Victorian-era birthing implement, a basket that had likely been in continuous use since the hospital opened in 1960, the year Nigeria became independent.

Despite the heat of the mid-July rainy season, the deputy ward matron dressed the child in a terrycloth jumpsuit, booties, and a large winter hat. Then she triple-gloved her hands and, holding the baby’s recently cut umbilical cord stump in her left hand, spread a thick layer of chlorhexidine gel along the length of the stump.

The infant was lucky on at least two counts. First, in a country where the minister of health tweets about Nigeria’s “broken health system”1 and the neonatal mortality rate is among the highest in the world, the child happened to be born in one of a handful of Nigerian states making a concerted effort to promote the use of chlorhexidine gel, a low-cost intervention that instantly reduced his chances of dying from the sort of massive infection that in Nigeria and other developing countries can all too easily take root in a newborn’s umbilical cord stump.

Last year Nigeria’s Federal Ministry of Health launched an ambitious plan aimed at making the immediate application of chlorhexidine to the stump the national standard of care. The five-year goal was to have the gel available and used on over half of the seven million Nigerian babies born each year.

Such a change would be a major challenge anywhere. In Nigeria—a roiling democracy of almost 200 million people that is Africa’s most populous country—it’s a daunting undertaking given ingrained cultural practices, a faltering infrastructure, health care workers who are often poorly trained, and a pervasive lack of money. The combination is frequently fatal for newborns.

But these factors did not conspire to take this infant boy’s life, which was his second piece of good luck. The previous night, twelve hours before he was born, the baby suffered a cord prolapse—a rare condition that occurs when a loop of the umbilical cord moves out of the uterus and into the vagina before the baby does. Standard procedure is to immediately perform a cesarean section, to avoid the possibility that when the baby’s head passes through the birth canal, it squeezes the cord and cuts off the baby’s blood flow and oxygen.

“It’s supposed to be an emergency,” the ward matron, Sallu Bose, says. “But it was no longer an emergency because of financial constraints.” Whose constraints? “The patient’s,” she explains.

Warm and candid, with rimless eyeglasses and a loud, infectious laugh, Bose has worked at the hospital for more than twenty-five years. On occasion, she will “stand in” for a patient who cannot find all of the money for a cesarean section, personally guaranteeing to provide the 30,000 Nigerian naira (roughly US$100) that it costs. This is a massive sum in a country where half of the population lives on the equivalent of less than US$2 a day. She is almost always paid back, Bose says, though it may take some time.

In this case, the mother and her family were able to collect the fee, although it took them twelve hours to do so. Bose says that after the cesarean was performed, the child needed oxygen because he had been born in fetal distress. Now, a short time later, he was dressed and lying in the newborn basket. But it was impossible to know exactly how he was faring, since there was no monitoring device in the maternity ward.

The state-run hospital and its four general practitioner physicians perform surgeries as well as deliver four to six babies a day. The hospital has one anesthesiologist and no obstetrician, explains Abdulraheem Sullayman, its medical director. Sometimes patients are operated on even when they cannot afford the fees, but not always. “We still have to pay for the equipment, the stitches, the gauze, the gloves, the drips, the blood bank,” he says, almost apologetically.

A lack of sufficient government funding is a constant problem in all sectors of the economy in Nigeria, which has a three-tier political structure: a federal government in the capital, Abuja, and thirty-six states plus the Federal Capital Territory. Each state is subdivided into local government areas (a total of 774 for the whole country), and each area is run by an elected council that administers primary health care clinics, among other things. But Nigeria’s limited financial resources are stretched even thinner by systemic corruption, state governors who wield near-total control of their own budgets, and a public sector that relies overwhelmingly on oil revenue—so much so that last year’s drop in oil prices sent Nigeria into its first full year of recession in a quarter-century.2

At the Okene Zonal Hospital in Kogi State, many of the staff members had gone for months without a paycheck. And doctors in the nearby Kogi State Specialist Hospital, in the state capital of Lokoja, were on strike because of the lack of pay.

“Everything has been politicized,” says Bose, whose ward has an incubator donated by several civic organizations that can’t be used because it runs too hot and because there’s no money, technician, or both (it’s not clear which) to fix it. Politicians, she says, “forget that this particular profession has to do with life and death.”

The infant, who had been moved from the basket and placed on the vinyl covering of one of the mattresses in the maternity ward, finally lets out a faint cry. “You are welcome,” says a doctor, using the ubiquitous phrase that Nigerians employ more as a greeting than a reply.

There are no silver bullets in global health care. But chlorhexidine—cheap, safe, and simple to use—comes close.

The math is not complicated. Neonatal deaths (that is, deaths of infants in their first twenty-eight days of life) occur almost exclusively in low- and middle-income countries, where some 2.7 million neonates die each year.3,4Infections are one of the top three killers of neonates. Luke Mullany, an early chlorhexidine researcher and a professor at the Johns Hopkins Bloomberg School of Public Health, notes that the rule of thumb is that countries with the highest neonatal mortality rates have the highest proportions of infection-related deaths, a figure that in some cases exceeds 40 percent.

Exposure to bacteria through the freshly cut umbilical cord is a common source of infection. As bacteria colonize the cord stump, it often develops a foul smell, and the bacteria can pass into the baby’s bloodstream. There, they become systemic, and all too often fatal neonatal sepsis is the result.

A coating of chlorhexidine gel every twenty-four hours until the stump falls off is the recommended protocol in Nigeria. Chlorhexidine, a topical antiseptic long used as an all-purpose skin cleansing agent in hospitals around the world, not only kills surface bacteria but also seals off bacterial entryways from the still partially open blood vessels in the stump.

A landmark cluster-randomized trial led by Mullany of more than 15,000 infants in 413 communities in Nepal found that applying chlorhexidine to the umbilical cord reduced neonatal mortality by 24 percent overall, and by 34 percent for those infants who had chlorhexidine applied within twenty-four hours of being born.5

Nigeria’s demographic characteristics mirror Nepal’s in two key areas: a very high neonatal mortality rate and a high share (estimated to be 63 percent) of home births—including some one million cases in 2013 in which women gave birth alone, with no one in attendance.6,7

With some 276,000 neonatal deaths annually in Nigeria (the country has the second-highest neonatal mortality rate in the world),8 it’s no wonder that the Federal Ministry of Health’s 2016 “National Strategy for Scale-Up of Chlorhexidine in Nigeria,” the government’s meticulously drafted road map, notes that “progress in reducing neonatal deaths globally is closely linked to results in Nigeria.”9

“A highly preventable mortality,” says Stephen Hodgins, a longtime chlorhexidine evangelist, referring to umbilical cord infections. “And in a high-mortality setting if you can knock off one out of five deaths, that’s a pretty big chunk to take out. If you can knock out what was causing 10 percent, you’ve accomplished something meaningful,” adds Hodgins, an associate professor at the University of Alberta’s School of Public Health.

OBSTACLES

The ministry’s national strategy was officially launched on November 17, 2016. Its ambitious goal is to use chlorhexidine on 52 percent of Nigerian newborns by 2021, a target that if reached will avert an estimated 55,000 newborn deaths in the five-year period.9 A year into the program, however, the enormity of the obstacles that must be overcome to reach that goal is becoming clear.

First, there is the task of establishing a reliable supply chain. While there are five certified domestic manufacturers of chlorhexidine gel, unregulated open-air drug markets that can compromise quality are rampant. And in a country twice the size of California, how do you move the chlorhexidine to thousands of clinics and hospitals in addition to the 200,000 private patent and proprietary medicine vendors—drug retail outlets—where the majority of Nigerians buy their medical supplies? The nation’s poorly developed infrastructure further complicates matters: Only 15 percent of Nigeria’s roads are paved, yet 90 percent of all freight travels by road.10,11

A second problem is creating demand. Most mothers (and their husbands and mothers-in-law), traditional birth attendants, and clinicians are still not aware of chlorhexidine and its benefits. And patent and proprietary medicine vendors are reluctant to stock products that nobody asks for. “You need strong demand generation, so shop owners know about it, and women and family members know about it, so the husband goes into [a] shop and they know to ask for it,” says Nikki Tyler, Market Access Advisor at the Center for Accelerating Innovation and Impact of the US Agency for International Development (USAID), who worked on the national strategy document. The vendors “are profit-oriented, so they need to know people will buy drugs in order for them to stock them.”

A third challenge is storage and handling. Chlorhexidine gel has a shelf life of three years in a normal temperature range. But Nigeria’s spotty electricity supply makes that impossible to guarantee. “In some places in Borno and Yobe States, the room temperature can be 40 degrees [104 degrees Fahrenheit],” says Ibrahim Ali, the genial but steely-eyed director of pharmacovigilance at the Nigerian Agency for Food and Drug Administration and Control (NAFDAC). “Even if you see power lines, there [may be] no electricity.”

Fourth, doctors can be stubborn when it comes to changing standard practices, insisting on a higher level of proof than community health workers do. It has long been a common practice for Nigerian doctors to wipe the umbilical cord stump with methylated spirits, a rubbing alcohol that evaporates quickly and doesn’t have the same bacteria-killing capacity as chlorhexidine. Jaiyeola Oyetunji—a doctor and a project manager at Jhpiego, the global health nonprofit associated with Johns Hopkins University—notes that the Nepal studies “showed that chlorhexidine was good, that it was beautiful. But it didn’t condemn methylated spirits.”

Just as difficult is overcoming families’ cultural practices that have solidified over generations. Traditionally, Nigerians have coated umbilical cord stumps with everything from olive oil to engine oil, using red toothpaste and Mentholatum in the south and herbs, salt, and even cow dung in the north in the hope of protecting the stump and, in many cases, helping it fall off more quickly.

It is not easy to convince families that such approaches do nothing to protect against infection, especially “when the mother-in-law comes and says: ‘This is what I used for your husband, and he’s still alive,’” explains Joshua Olorunfemi, Kogi State’s director of public health.

In fact, matters could be even worse, say health care workers, because at least there’s a tradition of applying something to the stump. This means that chlorhexidine is being promoted as a substitute for something else, not as a conceptually new intervention.

The final challenge is simply paying for everything. The national strategy estimates that it will cost US$32 million to reach its five-year goal of 52 percent chlorhexidine uptake. That means squeezing strapped state budgets and seeking money and expertise from a host of different domestic and international NGOs to conduct media campaigns, train health care workers to use chlorhexidine, and purchase and distribute hundreds of thousands of tubes of chlorhexidine to jump-start interest in the product until people are willing to pay for it themselves.

“Who’s organizing this program?” Matthew Durowaye, a consulting pediatrician in Lokoja’s Federal Medical Center, asks rhetorically. He is one of seven pediatricians in a state with an estimated population of 4.3 million.12 “It’s not the Kogi State government,” says Durowaye, referring to the July 2017 conference on chlorhexidine use he was attending that was paid for by USAID’s Maternal and Child Survival Program.

Yet even when a program is initially funded, organizers cannot be ensured of sustainable financing—that is, having resources available year after year after year. Indeed, in two states (Sokoto and Bauchi) that served as a model for successfully introducing the use of chlorhexidine in Nigeria, state purchases of the gel were halted after the election of new governors. The problem, says Olorunfemi, is that the “ability to get approval and release [of funds] depends on the relationship between the [state] commissioner [of health] and the governor. The funding of any government activity is based on having budget ownership, [and the budget] comes out every year.”

EARLY UPTAKE

Olakunle Ekundayo, the founder and managing director of Drugfield Pharmaceuticals Ltd., employs 700 people and has two pristine manufacturing plants an hour north of Lagos that can produce up to twenty-seven million tubes a year of Chlorxy-G Gel, as his brand is known. “It’s a simple product that has such a profound effect,” he says.

Seated at a small table in his spacious office, filled with photos and filing cabinets, Ekundayo says that domestic demand is far short of supply, and he has been selling his product elsewhere on the continent. “Yes,” he says, if one takes into account his “huge” initial investment, “we’re losing money. In absolute terms, yes.”

When Ekundayo began manufacturing chlorhexidine gel three years ago, his was the first company in Africa to do so. He says that the federal government’s imprimatur for nationwide implementation, combined with the fact that Nigeria had thirty-five million women of childbearing age, gave him hope that domestic demand was about to surge. “We thought the government says ‘that’s it’ and that’s it,” he says. “The thinking was, ‘This will be a volume spinner.’ But it didn’t happen that way. Uptake is still very slow.”

An August 2017 draft of the latest Multiple Indicator Cluster Survey of Nigeria, an international household survey developed by UNICEF to provide comparable global health data, puts chlorhexidine use at 3.9 percent nationally.13 A July 13, 2017, article in Devex, the global development website, by U.S. Pharmacopeia, a US nonprofit that helps countries modernize their drug manufacturing and that worked extensively with Drugfield, estimated the figure at 5 percent.14 However, no one really knows, because the government’s official Health Facility Daily Labour and Delivery Register, last updated in 2013, contains no column on chlorhexidine application. There are plans to update the register with a revised set of metrics, but there’s no guarantee that the new version will document chlorhexidine use—which is competing with a host of other indicators for the attention of public health officials. There are only so many columns available per page.

SHIFTING FOCUS

In the complex and competitive world of global public health, chlorhexidine has moved with enormous speed to a favored spot in the neonatal toolbox.

For decades, there was little agreement and conflicting evidence on the most effective umbilical cord stump care. Until the early 2000s, almost all studies on cord stump care were done in developed countries, evaluating dry cord care along with the use of antimicrobials such as chlorhexidine, triple dye, and alcohol. Radically different hygiene practices made it problematic to translate those results to the developing world.

Then came Mullany’s Nepal study in 2006, which was followed by two more (in Bangladesh and Pakistan) that also showed that chlorhexidine had a significant impact on mortality.15,16 In 2008 chlorhexidine was submitted for addition to the global essential medicines list of the World Health Organization (WHO); it was formally added in 2013.

In 2012 the UN Commission on Life-Saving Commodities for Women and Children—whose cochair was Goodluck Jonathan, then president of Nigeria—published a list of thirteen “overlooked” life-saving products for mothers, newborns, and older children.17 Chlorhexidine was one of the four commodities listed for newborns, and the commission estimated that its use worldwide could save 422,000 lives over the next five years.

In 2014 the WHO issued a formal recommendation—the ultimate accolade for a global health intervention—that chlorhexidine be used for cord stump care in home births in countries with a neonatal mortality rate of thirty or more deaths per thousand live births.18 (The Nigerian policy makes no distinction between home or facility births, calling for the application of chlorhexidine in both situations.)

Currently, twenty-seven countries in Asia and Africa either have a pilot program for the use of chlorhexidine or an aligned policy or are scaling up the use to a national level.19
It is no coincidence that the swift climb of chlorhexidine coincides with neonatal mortality’s rise as a hot topic in global health.

It is no coincidence that the swift climb of chlorhexidine coincides with neonatal mortality’s rise as a hot topic in global health. For decades NGOs and public health officials had focused more broadly on child health, defined as health in the first five years of life, rather than on neonatal mortality. That began to change significantly in the early 2000s—sparked in part by the United Nations’ eight global Millennium Development Goals (MDGs). The fourth goal called for cutting the under-five mortality rate by two-thirds between 1990 and 2015.

By then, while it was clear that the neonatal mortality rate was falling, the child mortality rate was dropping faster. The United Nations called its decline of 53 percent between 1990 and 201520 “one of the most significant achievements in human history.” 21 As a result, deaths in the first twenty-eight days of life now account for almost 45 percent of all deaths that occur in a child’s first five years—up from 37 percent in 1990, according to data from the WHO and UNICEF.20,22

“We used to say ‘mother and child,’ and the ‘newborn’ was forgotten—it had dropped into the cracks,” notes Chinyere Ezeaka, the president of the Nigerian Society of Neonatal Medicine and a professor of pediatrics at the Lagos University Teaching Hospital, better known as LUTH. “The whole focus has shifted to the newborn, especially when we realized that reducing newborn mortality was the only way to achieve MDG 4.”

Indeed, one of chlorhexidine’s main attractions is that it goes well beyond preventing umbilical cord infections (no small thing, of course): It’s also a powerful catalyst for improving neonatal care in general.

“There’s a convening power to chlorhexidine,” says Nosa Orobaton, deputy director of the Maternal, Newborn and Child Health Program at the Bill & Melinda Gates Foundation in Seattle, Washington, who was the lead author of a seminal study in 2015 on chlorhexidine uptake in the two Nigerian states of Sokoto and Bauchi.23 Orobaton explains that as local communities and health care providers focus on chlorhexidine, they quickly become attuned to “a suite of things that really ought to be done anyway—antenatal care, misoprostol [used to treat postpartum hemorrhaging], delay [cord] clamping, washing your hands with soap and water, cutting the cord with a clean razor, putting the baby on the chest, not washing the baby.”

The twenty-five-gram tube of 7.1 percent chlorhexidine digluconate gel, the standard size that Nigeria has chosen to use to promote its national chlorhexidine strategy, is also small, discrete, and identifiable—an easy symbol for a politician to grasp.

In Nigeria, where state and local politics play an outsize role in even the most mundane health policy decisions, Orobaton says that chlorhexidine “can help a governor visualize an intervention and serve as a proxy for understanding primary health care. That’s part of what we were able to do in Sokoto and Bauchi.”

That’s apparently what happened in the central Nigerian state of Kogi over the summer of 2017, where Gov. Ahmad Bello, a wealthy forty-two-year-old businessman, decided to capitalize on his state’s introduction of chlorhexidine by paying for 24,000 tubes and providing them free to hospitals and pharmacies.

He replaced the original packaging of the Nigerian manufacturer, Drugfield Pharmaceuticals, with a new box that was identical in every way to the old one with two exceptions: the new box featured an image of the governor’s smiling face and had an infelicitous misspelling of the word umbilicalprinted in bold black letters noting the gel’s purpose: “FOR UNBLICAL CORD CARE.”

SCALING UP

The brown concrete building that houses Nigeria’s Federal Ministry of Health rises like a squat sand castle amid the ever-expanding cityscape of Abuja. It is here that the momentum—or inertia—for Nigeria’s national strategy for scaling up the use of chlorhexidine will be determined.

Bose Adeniran—a doctor and career civil servant who is now the ministry’s director of child health and a key player in the scale-up—works out of a tenth-floor office. She is peering into her smartphone when asked about the challenges of the chlorhexidine launch. “You don’t start with the challenges,” she responds sharply, implying that the question was too fraught to begin a conversation. A few seconds later she relents. “The cost of implementation is where we have challenges,” she says.

Indeed, although a dozen or more states have purchased chlorhexidine either with their own funds or donor monies, the procurement process so far is continuing only in a few states (including the most populous, Lagos) that have focused on the sustainability and institutionalization of chlorhexidine’s use, says Olayinka Umar-Farouk, the project’s official “uptake coordinator” and its unofficial chief lobbyist. A public health physician, Umar-Farouk is responsible for running interference, setting up training sessions, and cajoling and prodding the entire Nigerian health care establishment to make chlorhexidine use the country’s new standard for cord care.

Orobaton’s work, particularly in the far northern state of Sokoto in 2013, had proved that with enough community involvement, lots of publicity about the product, and the right message—that the use of chlorhexidine is consistent with the cultural tradition of applying something to the umbilical cord stump—a state could ramp up that use to a significant level.

“We wanted local evidence,” continues Adeniran, who says that thirty-four states sent health delegations to Sokoto to study the results. The key now, she adds, is the individual implementation in each state. This will vary depending on factors such as the frequency of antenatal care visits, whether a community’s key “influencers” can be convinced of chlorhexidine’s benefits, the rate of home births versus facility births, the number of private facilities versus public, and how often a skilled birth attendant is available. “No one cap fits it all,” she says.

In July and September, two comprehensive, two-day-long zonal meetings —each convening representatives of about half of the states—were held in Lagos and Abuja. At these meetings, senior state health officials were briefed on such subjects as the role of jingles in creating demand, how to use money from the World Bank’s Saving One Million Lives program for chlorhexidine purchases, and avoiding confusion between chlorhexidine gel and erythromycin—an eye ointment that is also used on newborns. Adeniran was at both meetings. Ali, the federal drug regulator from NAFDAC, attended the Lagos meeting and sent a representative to the Abuja meeting. Their presence, notes Umar-Farouk, helped bolster the gel’s reputation as a high-quality product.

A year from now, Adeniran says, there should be enough feedback from most of the states to see how far the country has moved toward full implementation of chlorhexidine. It might even be possible to start formally tracking the substance’s use nationwide. Now that is possible in only two states, including Kogi—where a chlorhexidine column has been manually added to the official copy of the Health Facility Daily Labour and Delivery Register.

GUARDED OPTIMISM

Progress lurches forward, and improvements in Nigerian health care are no exception. The country quelled a potentially disastrous Ebola outbreak in 2014 with an immediate and rapid response—a textbook example of infectious disease control that the WHO called a “piece of world-class epidemiological detective work.”24

But reaching the national strategy’s five-year goal of just over 50 percent for chlorhexidine uptake, much less ever coming close to 100 percent, is more problematic and highly dependent on the vagaries of elected governors, whose states differ greatly on various health metrics. For example, in four northwestern states, more than nine out of ten babies are delivered at home, while in Imo State in the southeast, that figure is fewer than one in ten.6

When resources are applied and efforts made, however, change does occur, and the idea that the use of chlorhexidine gel should be the normal standard of care can take hold.

That’s why Umar-Farouk, checking on the progress of implementation at the Federal Medical Center in Lokoja, is able to joke about an empty carton of Oral-B toothpaste she spots at the foot of a patient’s bed.

“I want to believe that’s for the teeth, not for the cord,” she shouts in mock horror to the head of the labor and maternity ward.

Christiana Ajileye, the nurse in charge of the ward, laughs. “They are using it,” she says of the chlorhexidine widely available in the ward. “They are testifying that it’s easier than methylated spirits,” she continues, noting that use of spirits requires cleaning the cord stump four to five times a day with a cotton ball, compared to the single daily application required with chlorhexidine.

“And they have been testifying that it [the stump] falls off in time,” she adds, with some emphasis, alluding to one of the thorniest issues in the world of chlorhexidine: the belief that its application delays the time when the umbilical cord stump breaks away.

That matters to many Nigerians, who want their baby’s cord stump to have fallen off before an all-important naming ceremony, which usually occurs 7–12 days after a child’s birth, depending on the ethnic group. The ceremony effectively ratifies a child’s existence and welcomes him or her into the community. There is evidence that chlorhexidine can delay the stump’s loss by a day or so, but it’s certainly not clear that other ointments will make it fall off any sooner.
The most powerful motivator to change could be the most obvious: Fewer infants will die.

Ultimately, the most powerful motivator to change could be the most obvious: Fewer infants will die. “That infected smelling of the cord, we don’t have that now,” says Fatima Yakubu, a community health extension worker at a primary health care facility surrounded by a rutted dirt road in rural Kogi State. “That’s what we’ve witnessed.”

ACKNOWLEDGMENTS

Travel funding for this article was provided by a grant from the Pulitzer Center on Crisis Reporting, in Washington, D.C.

NOTES
1 On July 22, Minister of Health Isaac Adewole tweeted a link for an op-ed to his more than 7,000 followers. Adewole I. Opinion: Nigeria’s humanitarian crisis offers an unlikely opportunity to fix the broken health system. Devex Newswire[serial on the Internet]. 2017 Jul 21 [cited 2017 Oct 4]. 

2 World Bank. Nigeria: bi-annual economic update: fragile recovery [Internet]. Washington (DC): World Bank; 2017 Apr[cited 2017 Sep 26]. Available from: http://documents.worldbank.org/curated/en/349511494584937819/pdf/114996-WP-P163291-PUBLIC-NEUNoFinalfromPublisher.pdf

3 UNICEF. The neonatal period is the most vulnerable time for a child [Internet]. New York (NY): UNICEF; [updated 2016 Jan; cited 2017 Sep 26]. Available from: https://data.unicef.org/topic/child-survival/neonatal-mortality/

4 Lawn, JE, Cousens, S, Zupan, J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891–900.
5 Mullany, LC, Darmstadt, GL, Khatry, SK, Katz, J, LeClerq, SC, Shrestha, S Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet. 2006;367(9514):910–8.
6 National Population Commission, ICF International. Nigeria: 2013 Demographic and Health Survey: key findings[Internet]. Rockville (MD): The Commission and ICF; 2013 [cited 2017 Sep 26]. Available from: https://dhsprogram.com/pubs/pdf/SR213/SR213.pdf

7 Fapohunda, B, Orobaton, N, Austin, A. Women delivering babies at home with no one present is unacceptable. MHTF Blog [blog on the Internet]. 2016 May 26 [cited 2017 Sep 26]. Available from: https://www.mhtf.org/2016/05/26/women-delivering-babies-at-home-with-no-one-present-is-unacceptable/

8 Lawn, JE, Blencowe, H, Oza, S, You, D, Lee, AC, Waiswa, P Every newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384(9938):189–205.
9 Federal Ministry of Health. National strategy for scale-up of chlorhexidine in Nigeria [Internet]. Abuja: The Ministry; 2016 Mar [cited 2017 Sep 26]. Available from: http://www.healthynewbornnetwork.org/hnn-content/uploads/NATIONAL-STRATEGY-FOR-SCALE-UP-OF-CHX-IN-NIGERIA-FINAL-002.pdf

10 Central Intelligence Agency. The world factbook: field listing: roadways [Internet]. Washington (DC): CIA; [cited 2017 Sep 26]. Available from: https://www.cia.gov/library/publications/the-world-factbook/fields/2085.html

11 Elebeke, E. Nigeria paved only 28,980km out of 193,200km road network in 55 yrs—Fashola. Vanguard [serial on the Internet]. 2016 May 24 [cited 2017 Sep 26]. Available from: https://www.vanguardngr.com/2016/05/nigeria-paved-28980km-193200km-road-network-55-yrs-fashola/

12 City Population. Kogi: state in Nigeria [Internet]. Oldenburg (Germany): City Population; 2015 Mar 21 [cited 2017 Sep 26]. Available from: https://www.citypopulation.de/php/nigeria-admin.php?adm1id=NGA023

13 Nigeria National Bureau of Statistics and UNICEF. Multiple Indicator Cluster Survey 2016–17, survey findings report: draft. Abuja: NBS; 2017 Aug.
14 Generation next: ensuring quality medicines for newborns. Devex Newswire [serial on the Internet]. 2017 Jul 13[cited 2017 Sep 26]. Available from: https://www.devex.com/news/sponsored/generation-next-ensuring-quality-medicines-for-newborns-90268#.WWjEXW1Rst8.twitter

15 Arifeen, SE, Mullany, LC, Shah, R, Mannan, I, Rahman, SM, Talukder, MR The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. Lancet. 2012;379(9820):1022–8.
16 Soofi, S, Cousens, S, Imdad, A, Bhutto, N, Ali, N, Bhutta, ZA. Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Lancet. 2012;379(9820):1029–36.
17 UN Commission on Life-Saving Commodities for Women and Children. Commissioner’s report [Internet]. New York (NY): United Nations; 2012 Sep [cited 2017 Sep 26]. Available from: http://www.unfpa.org/sites/default/files/pub-pdf/Final%20UN%20Commission%20Report_14sept2012.pdf

18 World Health Organization. WHO recommendations on postnatal care of the mother and newborn [Internet]. Geneva: WHO; 2014 [cited 2017 Sep 26]. Available from: http://apps.who.int/iris/bitstream/10665/97603/1/9789241506649_eng.pdf?ua=1

19 Healthy Newborn Network. Chlorhexidine for umbilical cord care [Internet]. Seattle (WA): Chlorhexidine Working Group; [cited 2017 Sep 25]. Available from: https://www.healthynewbornnetwork.org/issue/chlorhexidine-for-umbilical-cord-care/

20 UNICEF. Child survival: under-five mortality [Internet]. New York (NY): UNICEF; [last updated 2016 Oct; cited 2017 Sep 26]. Available from: https://data.unicef.org/topic/child-survival/under-five-mortality/

21 UNICEF. Committing to child survival: a promise renewed: progress report 2014 [Internet]. New York (NY): UNICEF; 2014 Sep [cited 2017 Sep 26]. p. 12. Available from: http://files.unicef.org/publications/files/APR_2014_web_15Sept14.pdf

22 World Health Organization. Newborns: reducing mortality [Internet]. Geneva: WHO; 2016 Jan [cited 2017 Sep 26]. (Fact Sheet). Available from: http://www.who.int/mediacentre/factsheets/fs333/en/

23 Orobaton, N, Abegunde, D, Shoretire, K, Abdulazeez, J, Fapohunda, B, Lamiri, G A report of at-scale distribution of chlorhexidine digluconate 7.1% gel for newborn cord care to 36,404 newborns in Sokoto State, Nigeria: initial lessons learned. PLoS One. 2015;10(7):e0134040.
24 World Health Organization. Are the Ebola outbreaks in Nigeria and Senegal over? [Internet]. Geneva: WHO: 2014Oct 14 [cited 2017 Sep 26]. Available from: http://www.who.int/mediacentre/news/ebola/14-october-2014/en/