CHOLERA AND KENYA'S IDPS

What is cholera?

Cholera is an acute diarrheal infection of the intestine caused by ingestion of the bacterium Vibrio cholerae;(v.cholerae is responsible for releasing the toxin called cholerae toxin or {CT}which in turn is responsible for causing the mucosal cells to hypersecrete water and electrolytes into the lumen of the gastrointestinal tract. The result is profuse watery diarrhea, leading to dramatic fluid loss "rice water stools"is its hallmark)- which is fluids and mucous flecks.

Transmission occurs through direct faecal-oral route/ contamination or through ingestion of contaminated water and food and not limited to exposure of disrupted skin and mucosal surfaces to contaminated water. The disease is characterized in its most severe form by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and hypotention leading to shock. Without treatment, death can occur within hours due to severe dehydration and kidney failure.

The extremely short incubation period - two hours to five days - enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the environment, potentially infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV and the elderly are at greater risk of death if infected by cholera.

How does a person get cholera?

Two serogroups of V. cholerae - O1 and O139 - can cause outbreaks. The main reservoirs are human beings and aquatic sources, often associated with algal blooms (plankton). Recent studies indicate that global warming might create a favourable environment for V. cholerae and increase the incidence of the disease in vulnerable areas. V. cholerae O1 causes the majority of outbreaks worldwide. The serogroup O139, first identified in Bangladesh in 1992, possesses the same virulence factors as O1, and creates a similar clinical picture. Currently, the presence of O139 has been detected only in South-East and East Asia, but it is still unclear whether V. cholerae O139 will extend to other regions. Careful epidemiological monitoring of the situation is recommended and should be reinforced. Other strains of V. cholerae apart from O1 and O139 can cause mild diarrhoea but do not develop into epidemics. A person may get cholera by drinking water or eating food contaminated with the v. bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.

The v. bacterium may also live in the environment in brackish rivers and coastal waters. Under cooked sea food e.g. Shellfish if eaten raw have been reported as a source of cholera. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not at risk of becoming ill. However, eating in one plate or preparing meals with persons who are carriers and failed to wash their hands after a long visit to the bathroom/latrine is deemed unsafe.

ALL in all- Cholera is mainly transmitted through contaminated water and food and is closely linked to inadequate environmental management. The absence or shortage of safe water and sufficient sanitation combined with a generally poor environmental status are the main causes of spread of the disease. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met.

However, it is important to stress that the belief that cholera epidemics are caused by dead bodies after disasters, whether natural or man-made, is false. Nonetheless, rumours and panic are often rife in the aftermath of a disaster. On the other hand, the consequences of a disaster -- such as disruption of water and sanitation systems or massive displacement of population to inadequate and overcrowded camps -- can increase the risk of transmission, should the pathogen be present or introduced.
What to do to avoid getting cholera when you are a way from home?

Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water.
Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself. Avoid undercooked or raw fish or shellfish, including ceviche.Make sure all vegetables are cooked avoid salads. Avoid foods and beverages from street vendors-the likes of Muturas.
A simple rule of thumb is "Boil it, cook it, peel it, or forget it"

Is a vaccine available to prevent cholera?
Oral cholera vaccines:

The use of the parenteral cholera vaccine has never been recommended by World health organization due to its low protective efficacy and the high occurrence of severe adverse reactions. An internationally licensed oral cholera vaccine (OCV) is currently available on the market and is suitable for travellers. This vaccine was proven safe and effective (85–90% after six months in all age groups, declining to 62% at one year among adults) and is available for individuals aged two years and above. It is administered in two doses 10-15 days apart and given in 150 ml of safe water. One such example of recently developed oral vaccine for cholera is Dukoral from SBL Vaccines. It is licensed and available. The vaccine appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine.

Prevention and control of Cholera outbreaks:

Among people developing symptoms, 80% of episodes are of mild or moderate severity. Among the remaining cases, 10%-20% develop severe watery diarrhoea with signs of dehydration. If untreated, as many as one in two people may die. With proper treatment, the fatality rate should stay below 1%.

Measures for the prevention of cholera have not changed much in recent decades, and mostly consist of providing clean water and proper sanitation to populations potentially affected. Health education and good food hygiene are equally important. In particular, systematic hand washing should be taught. Once an outbreak is detected, the usual intervention strategy is to reduce mortality by ensuring prompt access to treatment and controlling the spread of the disease.

The majority of patients - up to 80% - can be treated adequately through the administration of oral rehydration salts- repackaged mixture of sugar and salts to be mixed with water and drunk in large amounts (standard sachets). Very severely dehydrated patients are treated through the administration of intravenous fluids, preferably Ringer lactate. Appropriate antibiotics can be given to severe cases to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed and shorten the duration of vibrio excretion. Routine treatment of a community with antibiotics, or "mass chemoprophylaxis", has no effect on the spread of cholera and can have adverse effects by increasing antimicrobial resistance. In order to ensure timely access to treatment, cholera treatment centres should be set up among the affected populations whenever feasible.The provision of safe water and sanitation is a formidable challenge but remains the critical factor in reducing the impact of cholera outbreaks.

Recommended control methods, including standardized case management, have proven effective in reducing the case-fatality rate. Comprehensive surveillance data are of paramount importance to guide the interventions and adapt them to each specific situation. In addition, cholera prevention and control is not an issue to be dealt by the health sector alone. Water, sanitation, education and communication are among the other sectors usually involved. A comprehensive multidisciplinary approach should be adopted for dealing with a potential cholera outbreak.

CAN KIBAKI RENEGE ON POWER-SHARING DEAL?

National Accord and Reconciliation Act, No 4 of 2008 and the Constitution of Kenya (Amendment) Act, 2008, were passed and given assent by the President and became effective on March 20.The Acts demand that there be a Prime Minister and that the coalition Government reflect the parliamentary strength of the respective parties and that there be “…portfolio balance.”

As the new law states, the Prime Minister is automatically the parliamentary leader of the largest political party.

Therefore, the coalition government is based on the pro rata parliamentary strength of each political party forming the coalition. The coalition comprises ODM, PNU, ODM Kenya and Kanu, their shares in the coalition in the same descending order and including portfolio balance. ODM is therefore the senior partner.....

DONALD B. KIPKORIR has this in details in his DN article

REACTION TO OBAMA'S SPEECH A WEEK AFTER IT WAS GIVEN

Tananarive Due and Steven Barnes wrote in huffingtonpost about sen.Barack Obama's speech a week after it was given and explores its deeper meaning.


What a difference a week makes.....

The Friday before Good Friday, I began my weekend with a sick feeling in my stomach that returned every time I switched on the news. Barack Obama's pastor, Rev. Jeremiah A. Wright, was everywhere. The pastor's incendiary remarks were being played and replayed, and I knew instantly that of all the threats to Barack Obama's candidacy thus far, none had been so potent--nor so utterly personal.

What was Obama to do? Having attended black churches myself (and having been raised by civil rights activists), I understood the cultural context of his pastor's remarks--even those I did not agree with. Having read Obama's memoir, Dreams from My Father, I had some knowledge of Wright's place in Obama's heart. Wright had guided Obama's path to Christianity. How can that relationship be put into words? How can you convincingly disavow someone who, despite his flaws, has meant so much to you?
Read the rest of the article

REACTION TO OBAMA'S SPEECH ON RACE IN AMERICA

This is a follow-up to the speech that sen. Barack Obama gave in Philadelphia on Tuesday March 18,2008. This afternoon on NPR'S talk of the nation by Neal Conan, I happened to switch on the radio on my way to work and i found the program to be very interesting.

Here we go:

......Sen. Barack Obama spoke on Tuesday about the role race has played in the presidential campaign and addressed the racially charged remarks made by his longtime pastor, the Rev. Jeremiah Wright. Guests and callers weigh in on the ways in which Americans talk about race in public and in private.

Guests:

1)Erin Aubry Kaplan, columnist for The Los Angeles Times, author of the op-ed "Black Isn't Enough"

2)Robert Jensen, professor of journalism at the University of Texas; author of The Heart of Whiteness: Confronting Race, Racism and White Privilege

3)Michael Meyers, executive director of the New York Civil Rights Coalition; author of the Los Angeles Times op-ed "Obama Blew It"

4)Gustavo Arellano, writer of the Ask a Mexican column....


HERE IS THE AUDIO PART

OBAMA'S SPEACH ON "RACE" IN AMERICA

There is a seven page text making rounds that's been prepared for delivery by Senator Barack Obama in Philadelphia.The speech is about race in America. It is understood that this is in response to the Rev. Wright's controversy.

TRANSCRIPT:

“We the people, in order to form a more perfect union.”

Two hundred and twenty one years ago, in a hall that still stands across the street, a group of men gathered and, with these simple words, launched America’s improbable experiment in democracy. Farmers and scholars; statesmen and patriots who had traveled across an ocean to escape tyranny and persecution finally made real their declaration of independence at a Philadelphia convention that lasted through the spring of 1787..... READ MORE HERE

LET ALL MPS JOIN HANDS IN PREACHING PEACE

There are some good news coming from a section of politicians who now appear to understand the magnitude of the aftermath of the Dec.27, 2007 disputed/discredited elections. Of note are the statements of Mr. William Ruto and Mr. Najib balala among others.

This weekend Ruto made statements that many will term as positive and headed in the right direction. “The Government we are about to form will not be pegged on sharing positions. Those out for positions should do so quickly and give us ample time to get down to real business,” he said.

He also supported Musalia Mudavadi for the post of deputy prime minister in the proposed coalition Government-this is after there appeared to be some frictions already beginning to show within the ODM ranks when three ODM MPs – Mr Kipkalya Kones, Mr Franklin Bett and Dr Julius Kones – said the sharing of power within ODM should be based on the voting pattern in the December election.

"If we gave more votes than the North Rift, we the Kipsigis should get the bigger portion,’’ Bett said. Dr Julius Kones added: "We support the power deal but not just on the horizontal basis between Kibaki and Raila, ODM and PNU, but we need to let it trickle down to the grassroots. This is ODM’s greatest test.’’It is understood that Ruto's statements were aimed at such stances while clarify and showing the bigger picture of what lies a head.

And while at it, he(Ruto) appealed to leaders to stop arguing over political positions and instead concentrate on fulfilling promises made to the people. The Eldoret North MP warned politicians not to reduce the sacrifices made in the past few months to a scramble for positions.

“Life and property have been lost. Let’s not talk about positions when many people are still living in camps as refugees in their own country,” he said.

The MP added: “Kenyans should pull up their socks, tighten their belts, roll up their sleeves and deal with various historical injustices, marginalization problems and tribalism that is tearing the country apart.” He added “it’s time for us to make sacrifices, like other Kenyans, in order to begin in earnest to solving problems affecting Kenyans instead arguing about positions”.

Balala on his part together with other MPs urged coastal communities to promote peace following the political crisis that rocked the country after the disputed polls. Lets hope that these are not mere empty isolated statements aimed at achieving cheap political mileage but, a true change of heart and a willingness to put the country before personal interests.And shall we demand that, the rest join-hands and together in unison to lift this country up.

MUTHAURAS OF KENYA NEED TO BE PUT ON NOTICE

It was refreshing to read an accurate take on the Muthaura's last week's press conference.
D. KIPKORIR said this much...

On Monday(03/10/2008), the head of public service, Mr Francis Muthaura, with Government spokesman Alfred Mutua in tow, called a press conference and, with the national flag in the background, told Kenyans what he called the Government’s understanding of the power-sharing agreement signed by President Kibaki and ODM leader Raila Odinga.

In particular, he said the pact was restricted to assigning Mr Odinga the title of prime minister, maybe a security escort and half the Cabinet, and that is all. With respect to Mr Muthaura, his understanding of the deal is pedestrian, off-course and misleading.

The National Accord and Reconciliation Bill, 2008, and the Constitution of Kenya (Amendment) Bill, 2008, were published on March 6, setting in motion the legislative process to enact them into law.

The Reconciliation Bill sets out the details of the power-sharing agreement and, once enacted, will be an ordinary statute. The constitutional Bill merely intends to embed the statute in the Constitution and thus make the pact constitutional.

Dual process

The dual process of having a statute with the details, and then a mere insertion in the Constitution that says that the statute is part and parcel of the Constitution, is novel and precedent-setting in our constitutional jurisprudence. I guess the exigency of the moment was an inspiration to the people who drafted the Bills.

But drafting was the only point of convergence of ODM of Mr Odinga and President Kibaki’s PNU.

The heart and gist of the Reconciliation Bill states that the prime minister, who shall come from the largest political party in Parliament, shall “ … coordinate and supervise … the affairs of the Government, including those of ministries …”

The Constitution Bill will amend Sections 3, 15 and 17 of the Constitution to make the Reconciliation Bill part of the supreme law and make it supersede all other provisions of the Constitution and Acts of Parliament that shall be inconsistent with it.

What then are the true meanings of the two Bills? Before attempting to understand them one needs to know two things — that they are in law called enabling statutes as they are intended to create new offices and powers, and it is the exclusive province of Parliament to make laws and for courts to interpret them when there is a conflict.

In interpreting statutes, one has to look at several established parameters and principles. And of paramount importance is to give effect and efficacy to the intention of Parliament in legislating them.

The preamble to the two Bills, to which President Kibaki and Mr Odinga appended their signatures, is clear and states: “The crisis triggered by the 2007 disputed presidential elections …threatens the very existence of Kenya … neither side can … govern the country without the other. There must be real power sharing …”

Any interpretation of the Bills must, therefore, never contradict the intentions and objectives of what the President and Mr Odinga signed.

Both leaders have a duty to give Kenyans a joint statement of what they meant, and one side should not give a disputed position. As ODM has rejected Mr Muthaura’s statement, it must be taken that his statement was a personal view.

Further, meanings of Bills must be unambiguous and mean what they say as well as create consistency.

Every person is free to consult their dictionaries to get the meanings of the operative words that create the office of and give powers to the prime minister.

If words used in a Bill are meaningless or give contradictory and ambiguous dictionary meanings, it behoves Parliament to correct them.

The Bills say that the prime minister shall have “… authority to coordinate and supervise …” functions and affairs of the Government, including ministries.

The simplest dictionary meaning of this is that the prime minister shall have power — real power — to superintend and oversee all powers of government and ministries to create order, harmony and organization. The words cannot have a clearer meaning.

Government and ministries mean what they say; this is the entire Executive arm. The other arms of the State are the Legislature and the Judiciary.

Government and ministries include the entire civil service, the armed forces, the provincial administration, the diplomatic corps and the parastatals.

Supervisory role

The prime minister will thus have the overall supervisory and coordinating role over the entire Executive to its fullest extent as long as this does not conflict with the overall powers of the President as set out in sections 23 and 24 of the Constitution.

As the creation of the office and the powers of the prime minister was by President Kibaki’s agreement, we must take it to mean that their powers shall be seamless.

My understanding is that the prime minister shall be a co-president. The premier will, therefore, exercise all executive powers, except that of being commander-in-chief of the armed forces and receiving diplomatic accreditations.

The other interpretations of statutes are more scientific and are the preserve of the courts. Meanings beyond the clear, ordinary and unambiguous are left to the courts.

This interpretation is to create logic and consistency in the entire legal body to remove any unintended consequences. However, the power of the courts leaves it to the individual persuasion, philosophy and, tragically in Kenya, the judge’s tribe.

However, the judges will still be guided by history, context and public policy in their interpretation. The two Bills are, as admitted in the preamble, caused by the ineptitude and incompetence of the Electoral Commission which left Kenyans in doubt as to who the president is.

It will take a very unpatriotic and completely incompetent judge to give a meaning that is contrary to this history, context and public expectations.

Kenya needs to heal and move forward, and it is evident that the President and Mr Odinga know what we expected, and do expect, of them.

In the next one week or so Parliament, through a guillotine process, will enact the two Bills into law. The House is wholly empowered to have short-cuts in its procedure when there is cause, and isn’t there one now?

The Reconciliation Bill needs a simple majority of Parliament to be passed, whereupon it will be gazetted and assented to by the President.

The Constitutional Bill needs 65 per cent of all MPs and, once passed, automatically becomes law without the presidential assent. Parliament and the attorney-general need, therefore, to work in sync to bring both Bills into operation at the same time and seamlessly.

In the meantime, Mr Muthaura and like-minded officers should stay clear of the roles of the AG and the courts.

Interpreting the law is not part of the duties of a civil servant, and I am surprised that Mr Moses Wetang’ula and Mr Mutula Kilonzo, lawyers of impeccable record, will want to acquiesce to Mr Muthaura’s amorphous and non-existent duty.

Besides, the office of the head of public service being non-constitutional, will be subservient and answerable to the prime minister. Section 19 of the Public Officer Ethics Act, 2003, makes it a criminal offence for a civil servant to give false or misleading statement to the public.

Our prefects, AG Amos Wako and the head of the Kenya Anti-Corruption Authority, Mr Justice Aaron Ringera, should read and enforce it.

As our nation-state is trying to heal, we must stand up against people who want to derail the process.

Kenya is bigger than individuals, and our objective is to move forward according to the road map given by the mediation chief, former UN secretary-general Kofi Annan, and his team.

We must go through all the agreed processes. Some people will have to lose power and others gain it, but Kenya must stand united.