News (Updated January 31 2010)

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To Benin , in search of a Princess Diana moment

This week, Carla Bruni-Sarkozy – French first lady, rock star, model and heiress – jetted to west Africa to highlight the HIV threat. Sarah Boseley accompanied her

Sarah Boseley

The Guardian, Saturday 30 January 2010

Carla Bruni-Sarkozy walked up the red-carpeted steps in her elegant black silk dress, smiling graciously to one side and then the other, cameras flashing. It could have been the Oscars. It could have been almost anywhere. But it was the presidential palace in one of the poorest countries in the world, Benin, a former French colony in west Africa, and along with the muttered questions about which designer she was wearing, one wag speculated about the make of her mosquito repellent.

Next week is the second anniversary of the marriage that had all the world agog. She was stunningly beautiful, an heiress to an Italian car tyre magnate, a top model for a decade who became a successful singer-songwriter, with a string of famous former lovers including Eric Clapton and Mick Jagger. He was Nicolas Sarkozy, president of France . It was Princess Diana all over again – but with a past that made Carla all the more exciting.

Two years on, France is still in love. She is "a rock star", they say, although there are complaints that she is relentlessly used by the Élysée to improve Sarkozy's image. Like Diana, her photograph is everywhere. Unlike Diana, she has insisted on her own life and career. A fourth album is on its way. She has agreed to a film with Woody Allen.

This week she was in Benin because she has conformed to French first lady tradition by taking up a cause. Bernadette Chirac backed a charity helping anorexics, because her older daughter suffered severely from the eating disorder. Bruni-Sarkozy, whose brother Virginio died of Aids, became ambassador to the Global Fund to Fight Aids, Tuberculosis and Malaria just over a year ago, focusing on a single, poignant, issue – getting the right drugs and help to women with HIV who are pregnant, so that their babies can be born free of the virus.

Yet this is only Bruni-Sarkozy's second field trip for the fund. Last February, she went to Burkina Faso . Apart from a high-profile speaking engagement in New York , the rest of her work seems to have been confined to lending her name to newspaper articles. Her contact with real people has been minimal: she arrived in Benin in a 15-seater French military aircraft on Monday, had dinner with the president and his wife on Tuesday evening, toured a small Catholic mission hospital on Wednesday morning and flew home after lunch.

I asked a woman with HIV with a baby on her lap – one of about 50 seated on plastic chairs in the dust outside the hospital – who she had been waiting for since 7am. "An important foreigner," she said. Two women inside knew it was the French president's wife, but described Melinda Gates, who had joined her for a morning during her own, rather longer, African tour.

In an interview in a consulting room, Bruni-Sarkozy spoke about the courage of women in Benin whose husbands leave them when they find they are HIV-positive. "One of them told us at the end if you help us, we hold the family, so if you help us, we'll take care of them," she said, speaking in good but occasionally awkward English.

"The men are the great denialists about this great honte – shame – and they still cannot face it. So that's a problem. It's not a practical problem – this is a deep societal and cultural problem."

Cultural problems are not the remit of the Global Fund. It is a financing mechanism, launched by former UN secretary general Kofi Annan in 2001 to raise money from donor governments originally to pay for treatment programmes in poor countries and now, increasingly, for rather less sexy health system strengthening. So Bruni-Sarkozy's work is to support fundraising.

She does not much want to engage in the knottier issues. When asked whether she could suggest the pope should change his stance on condoms, which protect people from HIV, she gets very angry: "I think that this is a little bit political – and terribly useless. Useless for you and completely useless for me," she snaps.

Bruni-Sarkozy knows her limitations as an Aids campaigner. "There is not much I can bring to the Global Fund, but I can bring a visibility they didn't really have." Being a celebrity campaigner, she says, is a bit like potatoes and vodka in that the mundane details of her life eventually focus attention on a just cause: "You need 20 potatoes to make this glass of vodka. Maybe [celebrity] distracts but [if] I can bring the attention on something else, I feel like my public life is worth it, for me.

"Having such visibility and always keeping like an empty box – that really depresses me, you know?"

Coming to Africa , she says, puts her in touch with real life. "It's fantastic. I was telling Melinda [Gates] in the car I feel like my eyes are increasing their view and my ears have been opening. There's much more reality, I can feel much more the difficulties of people. I was very much protected from that in my previous life. I could have spent my life living in this happy bubble and I didn't."

So if Africa and the plight of women with HIV and their babies move her so much, why come for just two hours in the field?

"I wish I had more time … I cannot do it for two weeks; I have a little boy."

But while Bruni-Sarkozy says she would prefer only to talk about the serious issues, the Élysée staff accompanying her to Benin are busy briefing about her marriage. She wanted to fly back quickly, they say, because she wanted to be at home with her husband (odd, because Sarkozy was in Davos that evening). She lives in her own sumptuous house on a private street in a fashionable area of Paris , where Sarkozy joins her after work and they watch films together, the aides gush. They are like lovebirds. The French press talk of Élysée spin. They recollect Bruni's comment to a magazine that monogamy gets boring after two or three weeks. They also suggest that it was the government's idea that she should take up a cause related to Aids.

Bruni-Sarkozy can't win. Or can she? Princess Diana changed everything when she sat at the bedside of a man with Aids and held his hand. Had she lived, she might have embarrassed governments into banning landmines. So if she picks the right moment and the right issue, Carla Bruni-Sarkozy may yet go down in history for something more than her songs and her marriage.

Bill Gates says innovation can leverage change

By Donna Gordon Blankinship, Associated Press Writer Mon Jan 25, 2010

SEATTLE – The needs of the poor are greater than the money available to help them, but that's not enough to discourage Bill Gates in his work as co-chair of the world's largest charitable foundation.

In his second annual letter, issued Monday, Gates says investment in science and technology can leverage those dollars and make more of a difference than charity and government aid alone.

In his 19-page letter, Gates says the foundation currently is backing 30 areas of innovation including online learning, teacher improvement, malaria vaccine development, HIV prevention, and genetically modified seeds.

The Seattle-based foundation focuses most of its donations on global health, agriculture development and education. Since 1994, the foundation has committed to $21.3 billion in grants. As of Sept. 30, 2009, its endowment totaled $34.17 billion.

Gates said his and his wife's experience at Microsoft Corp. is not the only reason they are so taken with technology.

"Melinda and I see our foundation's key role as investing in innovations that would not otherwise be funded," he wrote. "This draws not only on our backgrounds in technology but also on the foundation's size and ability to take a long-term view and take large risks on new approaches."

Gates begins his letter by talking about how much fun he's having at his new job: 2009 was the first year he worked full-time as co-chair of the foundation, after a decade of part-time work as he led Microsoft full-time.

He talks about enjoyable visits around the world to talk to scientists, politicians, teachers, farmers and people doing the work of the foundation.

"Seeing the work firsthand reminds me of how urgent the needs are as well as how challenging it is to get all the right pieces to come together," Gates wrote. "I love my new job and feel lucky to get to focus my time on these problems."

He talked about the way he and Melinda work as partners at the foundation, each focusing on problems that interest them and then sharing what they've learned and making decisions together on what the foundation should do.

Nearly seven pages of the letter focus on the foundation's work in global health and repeatedly Gates admits the work to reach the foundation's ambitious goals is harder than they expected.

Vaccine development is progressing, but the cost to provide those vaccines to the poor is still a problem. It's going to be difficult to meet a six-year goal to get the retrovirus vaccine to more than half the kids who need it.

Bed nets are helping decrease malaria deaths over Africa , but "malaria is a particularly tricky disease," Gates acknowledges. The foundation has resorted to a very expensive scattershot approach to meeting Bill and Melinda's goal of eradicating malaria, with many researchers pursuing a lot of different ideas.

Despite having one vaccine in a Phase III trial, an effective malaria vaccine is still 8 to 15 years away, he said.

The economy rates a paragraph at the beginning and about two pages at the end of Gates' letter. He expressed concerns that budget deficits in the richest nations leading them to cut foreign assistance. He applauds Canada and Australia for their significant efforts and chastises Italy for not doing enough. Gates commended President Barack Obama for his proposal to double international aid.

The letter ends with Gates' explanation about why the foundation hasn't gotten involved in working to fight climate change, despite its potential impact on the poorest nations.

He said he believes developing electricity that is cheaper than coal and emits no greenhouse gasses is the most important innovation to help fight climate change, but the foundation has not yet found a way it can play a unique role in this area. He added, however, that outside of the foundation he personally is investing in energy research.

"I am surprised that the climate debate hasn't focused more on encouraging R&D since it is critical to getting to zero emissions," said the man who admits to spending some of his spare time watching online MIT lectures on physics and chemistry.

INDONESIA : Overcrowding fuels TB in prisons

JAKARTA , 25 January 2010 (IRIN) - Serious overcrowding, a shortage of medical staff and a lack of funding are thwarting Indonesia 's efforts to tackle tuberculosis (TB) in prisons, experts say.

Indonesia 's 422 prisons hold more than 140,000 inmates, even though they were designed for 80,000, according to the Justice Ministry.

The government started a programme to control TB in prisons in 2004 by adopting the so-called Directly Observed Treatment, Short-course or DOTS, a treatment strategy for detection and cure recommended by the World Health Organization (WHO).

But so far only 122 prisons in 17 of the country's 33 provinces have benefited from the DOTS programme, which receives support from the Global Fund, said Daniel Rasjid, head of the TB control strategy at the director general of the prison system.

"The main problem is overcrowding," Rasjid told IRIN. "Overcrowding makes it easy for diseases to spread and TB spreads much more easily compared to HIV because it doesn't require physical contact." A crackdown on drugs had contributed to the overcrowding, with most inmates, particularly in major cities, convicted of drug offences, he said.

Left untreated, each person with active TB can infect on average 10 to 15 people a year.

According to Justice Ministry data, 90 prisoners across the country died of TB in 2009, after 150 the previous year.

Indonesia , the world's fourth most populous nation of 230 million people, has the third-highest tuberculosis burden in the world, according to WHO. An estimated 140,000 Indonesians die from TB each year, according to Stop TB Partnership Indonesia, with TB the second leading cause of death after heart disease for all ages in the country, according to the Health Ministry.

And while little is known about the current prevalence of TB in Indonesian prisons, a Health Ministry study in 2005 showed that 1.7 percent of prisoners had TB, said Tjandra Yoga Aditama, the Health Ministry's director-general for disease control and environmental health.

That figure was 16 times as high as the prevalence of the disease among the general population, he said.

Aditama said in addition to overcrowding, a shortage of health specialists, poor sanitation, poor monitoring of prisoner transfers, and lack of awareness among prison officials and inmates contributed to the spread of TB.

"TB control and prevention measures cannot be carried out fully because of the poor conditions of prison buildings and infrastructure," Aditama said.

"But efforts are being made to [separate] inmates with TB from others, especially those who are vulnerable, such as people with HIV/AIDS," he said.

A prison TB surveillance system is still being developed applying the same standards used in the national TB control programme, he said.

Shortage of doctors

Rasjid said prisons in provinces such as Aceh and Papua had no permanent doctors while in places such as Maluku, East Nusa Tenggara and West Nusa Tenggara, one doctor was solely responsible for all the prisons.

Doctors working for the local health department made irregular visits to these prisons, sometimes once in two weeks, Rasjid said.

"Doctors and nurses are at the forefront of the fight against TB. But most of more than 300 doctors we have serve in Jakarta and other prisons on Java island," he said.

Ideally a major prison should be served by two doctors, one dentist, two nurses and one lab technician, he said.

Funds allocated by the government were also insufficient to allow prisons to provide decent healthcare and meals, Rasjid said. "Let's say that the capacity of a prison is 700 people. Even if there are 2,500 inmates there, the food budget will cover only 700 people."

Muhammad Hatta, a consultant for the government's TB control programme, said there had been cases of multiple drug resistance (MDR) among prisoners.

About 2 percent of newly diagnosed TB cases in Indonesia are estimated to have developed MDR, WHO said.

Hatta said Indonesia 's TB fight was "failing" because it had been unable to maintain the continuity of medical supplies, with money mostly coming from foreign donors.

"Our TB programme depends heavily on foreign funds, including the provision of drugs," Hatta said. "There's been a lack of support on the part of the government as well as NGOs for TB programmes in prisons. There are hundreds of NGOs working on HIV/AIDS but very few are dealing with TB," he said.

He said the problem of overcrowding was so bad that in one instance, 50 people were cramped in a 25 sqm cell. "Inmates had to take turns lying down because there wasn't enough space for them all to lie down at the same time," he said.

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