Author: AFP

Tackling mycetoma: A medical success story in Sudan

Behind the brick walls of the Mycetoma Research Centre trying to unravel the mysteries of the infection is a rare story of medical success in impoverished Sudan.

With bandages on their swollen, deformed feet, patients from across the vast country arrive at the spotless facility set in a garden in the southern Khartoum district of Soba.

For more than 40 years, British-educated researcher Elsheikh Mahgoub has been searching for answers to the mysteries of mycetoma, a bacterial and fungal infection which can spread throughout the body resulting in gross deformity and even death.

Sudan is particularly affected by mycetoma, which is also endemic in a geographic belt including regional neighbours Chad, Niger, Nigeria, Ethiopia, Somalia, parts of Saudi Arabia and Yemen, experts say.

The belt also stretches to India and parts of Latin America.

Mycetoma is “a badly neglected disease”, the United Nations’ World Health Organisation (WHO) says on its website.

Yet in Sudan, researchers have been studying the condition since British colonial times, and the Khartoum centre has been globally recognised for its work.

Such acknowledgement in the health field is unusual for a country which ranks near the bottom of a UN human development index measuring income, health and education.

Mycetoma is characterised by swelling of the feet but it can eat away bone and spread throughout the body, causing grotesque barnacle-like growths, club-like hands and bulging eyes.

The traditional treatment was amputation – something the Sudanese centre tries to avoid.

Elsheikh Mahgoub, supervisor of Sudan's Mycetoma Research Centre, shows a picture of an infected foot on his computer. (Pic: AFP)
Elsheikh Mahgoub, supervisor of Sudan’s Mycetoma Research Centre, shows a picture of an infected foot on his computer. (Pic: AFP)

“Most patients who get it are farmers, or animal herders, and these are poor people,” says Mahgoub (78).

“They are poor, and they get poorer.”

Mahgoub says he established Sudan’s first mycetoma centre in 1968, working with a British nurse and a British technician.

“Many people thought: Why should I be concerned about this disease which is not common, which is difficult to diagnose, and difficult to treat?” he told reporters on a tour of the facility, which opened at its current location in the 1990s.

The centre offers diagnosis, treatment, training and research as part of Soba University Hospital under the University of Khartoum, which funds it along with some donors.

It has its own laboratory, two wards, and is served by seven part-time doctors as well as Mahgoub, the research supervisor, and its director A.H. Fahal, a professor of surgery.

Though its resources are limited, they have been used effectively, Fahal has written.

Patients come and go – with 6 400 registered so far – but Fahal remains and so does Mahgoub, challenged by the puzzle of why mycetoma is so prevalent in Sudan and neighbouring countries.

“I think there’s two things,” Mahgoub explains, pointing first to the organism’s presence in soil.

He says people who make their living from the land are more likely to get pricked by thorns, for example, from the Acacia trees which are widespread in the mycetoma-prone region and provide a route for infection.

Secondly, the patients have been found with weakened immune systems. Some not only have mycetoma but also Aids, leprosy, tuberculosis or other conditions, Mahgoub says.

“Why? Why these people? Is it nutritional, because of malnutrition? Is it because of the other diseases they get at the same time?”

He does not yet have the answers.

“But we know that they have got some deficiency in their cell-mediated immunity.”

Thorn jab 20 years ago
Mohammed al-Amien Ahmad is a typical case.

The farmer tells Mahgoub that a thorn jabbed him about 20 years ago.

“This thorn came out and it seemed to be OK. Later on the swelling came up. It was a bit itchy,” says the goateed farmer, who is in his 60s and wears a traditional white jalabiya robe.

Ahmad, his enlarged left foot oozing pus, has travelled more than 500 kilometres by bus from Umm Rawaba where he farms about 70 acres of sorghum.

His condition worsened over the past two years, he says, forcing him to reduce the amount of land he can work, and cutting into his annual income of 30 000 – 40 000 Sudanese pounds ($4 300 – $5 700).

In a majority of cases mycetoma is painless, meaning patients like Ahmad delay seeking medical care.

This makes treatment more difficult, Mahgoub says.

“The main thing we tell them is to come early… Because if the swelling is small it can be excised in total,” with follow-up medication, he says.

A patient's infected foot. (Pic: AFP)
A patient’s infected foot. (Pic: AFP)

The Mycetoma Research Centre provides diagnosis and any surgery patients may need for free. But patients may require months of anti-fungal medication, which they must buy themselves.

Some who cannot bear the financial burden stop taking their medicine, Mahgoub says.

“In that case the disease will just go back to where it started. That’s a real problem,” he says.

Drug prices in Sudan have climbed over the past two years as Sudan’s currency plunged in value and inflation soared.

Sudan’s health ministry has expressed concern about the emigration of doctors and other health professionals seeking better salaries and working conditions abroad.

Nationwide, there were 1.3 health workers per 1 000 people in 2011, against the WHO benchmark of 2.3.

Many primary health care facilities in Sudan “lack appropriate medical equipment and supplies, have inadequate infrastructure or are understaffed,” the United Nations said this year.

In contrast, the Mycetoma Research Centre “is recognised globally as a world leader”, an informal group of experts on the disease wrote after their first meeting this year in Geneva.

Ian Timberlake for AFP.

Zimbabwe elections 101

Zimbabwe is holding general elections today, which brings to an end the power-sharing government between President Robert Mugabe and his long-time rival Prime Minister Morgan Tsvangirai.

Robert Mugabe (L) and Morgan Tsvangirai. (Pic: AFP)
Robert Mugabe (L) and Morgan Tsvangirai. (Pic: AFP)

Here are some key facts about the vote:

  • Some 6.4-million Zimbabweans, out of a population of 12.9-million, are eligible to vote at 9 670 polling stations across the country.
  • Voting centres will be open from 7am to 7pm.
  • Most voters will vote for presidential and parliamentary candidates.
  • There are five presidential candidates: President Robert Mugabe, Prime Minister Morgan Tsvangirai, Dumiso Dabengwa, Welshman Ncube and Kinisoti Mukwazhe.
  • There are 210 parliamentary constituencies.
  • 60 seats are reserved for women.
  • 37 108 police officers and military personnel have already voted.
  • Voters will need to be 18 years and above to vote and will have to present a national identity card or a valid Zimbabwean passport.
  • The results are expected within five days.
  • If no candidate gets more than 50% of the vote, a runoff will be held, likely in September.

View the Mail & Guardian’s special report on the Zimbabwe elections here.

Fashion Week kicks off in DR Congo

While the army is battling rebels in the Democratic Republic of Congo’s unstable east, models prepared to sashay down the catwalk at the first Fashion Week in the capital Kinshasa.

Gloria Mteyu (29) told AFP that she had organised the three-day catwalk and fashion exhibition “to show that in Congo, there is not just war”.

Back-to-back wars that ravaged DR Congo from 1996 to 2003 have given way to a complex web of rebel groups still terrorising the eastern provinces, which are rich in mineral assets.

Even the world’s largest UN peacekeeping force has not managed to stop atrocities including the killing of civilians, using child soldiers and rape on a scale that has given the country the label of “rape capital of the world”.

Mteyu, who lives in New York, said ahead of the catwalk that beyond showing another side of DR Congo, she also wanted to give homegrown talents a platform.

“Because I myself am a designer, and since I have had the chance to go to other countries on several continents … I wanted to come home, do the same thing and organise a catwalk to showcase our talent, our Congolese style,” she said.

“We have not seen many Congolese at other Fashion Weeks so here is the first chance to showcase Congolese designers who work well,” she said.

(Pic: Kinshasa Fashion Week's Facebook page)
(Pic: Kinshasa Fashion Week’s Facebook page)

Twelve Congolese designers including Okasol, who dresses Papa Wemba, one of Africa’s most popular singers, and eight foreign designers including South Africa’s David Tlale, have been invited.

According to the event’s Facebook page, the organisers also made a casting call for models in Kinshasa this month.

Local residents however complained that ticket prices to the show were out of reach to most in the country where two-thirds of inhabitants live on less than a dollar a day.

A regular seat costs $150, while a package including two nights of catwalk and access to exhibitions costs $300.

“It is shocking. No one has access, only the rich are targeted. There is no chance for everyone to experience this. Even the middle class can’t go,” said Clarisse, who earns $200 a month.

Decrying the “astronomical prices” on the show’s Facebook page, Muriel T. Munga asked: “Who are you targeting? The Kinshasa High Society? If that’s who you’re targeting, then you have succeeded.”

“The first three rows will be packed… but the other rows will be empty,” she said.

Habibou Bangre for AFP

Mandela the boxer inspires Soweto gym-goers

In a sweaty township gym where Nelson Mandela once trained as a young boxer, athletes are still pumping iron today, inspired by the peace icon’s example as he fights for his life in hospital.

In the early 1950s, a youthful Mandela worked out on week nights at the Donaldson Orlando Community Centre, or the “D.O.” as it’s still affectionately known.

Spartan and slightly run down, the walls ooze with the intermingled history of sport, community life and the decades-long fight against apartheid oppression.

It was here that Mandela came to lose himself in sport to take his mind off liberation politics.

A young Nelson Mandela in boxing gear. (Gallo)
A young Nelson Mandela in boxing gear. (Gallo)

Nestled in the heart of South Africa’s largest township just south of Johannesburg, the community centre was also where famous African songbirds like Miriam Makeba and Brenda Fassie first performed.

The 1976 uprising against the imposition of the Afrikaans language in black schools were planned from the D.O. as Mandela and other leaders languished in apartheid jails.

“Here, look, these are the very same weights Madiba used for training,” proud gym instructor Sinki Langa (49) says.

“They have lasted all these years,” he said as he added another set to a bar his fellow trainee Simon Mzizi (30) was using to furiously bench-press, sweat dripping down his face.

Nearby, other fitness enthusiasts worked out to the tune of soothing music which, unusually for a gym, included opera.

The six metre-high 'Shadow Boxer' sculpture in Johannesburg's inner city depicts Nelson Mandela as a young boxer. (AFP)
The 6m-high ‘Shadow Boxer’ sculpture in Johannesburg’s inner city was unveiled in honour of Nelson Mandela in May 2013. (AFP)

‘Drenched with sweet memories’
The D.O. – or Soweto YMCA as it is called today – opened its doors in 1948, the same year the apartheid white nationalist government came to power.

Built with funds donated by Colonel James Donaldson, a self-made entrepreneur and staunch supporter of the now governing African National Congress, the D.O. centre includes a hall, and several sparsely furnished smaller rooms like the one where Mandela sparred as a young man.

Today the gym is housed in an adjacent hall, which was the original building on the grounds erected in 1932.

Mandela joined the D.O. in around 1950, often taking his oldest 10-year-old son Thembi with him.

In a letter to his daughter Zinzi, while on Robben Island where he spent 18 of his 27 years in jail, Mandela recalled his days at the gym.

“The walls … of the DOCC are drenched with the sweet memories that will delight me for years,” he wrote in the letter, published in his 2010 book Conversations with Myself.

“When we trained in the early 50s the club included amateur and professional boxers as well as wrestlers,” Mandela wrote to his daughter, who never received the letter because it was snatched by his jailers.

Training at the D.O. was tough and included sparring, weight-lifting, road-running and push-ups.

“We used to train for four days, from Monday to Thursday and then break off,” Mandela told journalist Richard Stengel in the early 1990s, while writing his autobiography Long Walk to Freedom.

When he was handed a life sentence in 1964, Mandela kept up the harsh regime of his training to stay fit and healthy.

“I was very fit, and in prison, I felt very fit indeed. So I used to train in prison … just as I did outside,” Mandela said in a transcript of his conversation with Stengel, given to AFP by the Nelson Mandela Centre of Memory.

Mandela was eventually released from jail in 1990 and in 1994 he was elected South Africa’s first black president.

‘He’s a fighter’
In Long Walk to Freedom, Mandela admitted he was “never an outstanding boxer”.

“I did not enjoy the violence of boxing as much as the science of it… It was a way of losing myself in something that was not the struggle,” Mandela wrote.

“Back in those days, boxing was very popular – it was part of that culture,” Shakes Tshabalala (81) who has been involved with the centre from the start told AFP.

Nelson Mandela (C) pretends to fight former US world middleweight champion Marvin Hagler (R) in Cape Town on November 12 1997 while former five-time world champion Roberto "Hands of Stone" Duran (L) of the US looks on. (AFP)
Nelson Mandela (C) pretends to fight former US world middleweight champion Marvin Hagler (R) in Cape Town on November 12 1997 while former five-time world champion Roberto “Hands of Stone” Duran (L) of the US looks on. (AFP)

Pugilism always played a big part in Mandela’s life. At his house-turned-museum at 8115 Orlando West, boxing-related items like the WBC World Championship belt donated by Sugar Ray Leonard are on display.

Back at the centre, a new generation of youngsters are training.

Although few of them box today, they draw their inspiration from Mandela’s example in healthy living.

While the ailing 94-year-old statesman is battling a recurring lung infection, the gym-goers firmly believe the liberation icon will return for one last round.

“Mandela was a sportsman. This is why today he is still alive,” said gym instructor Langa.

“I am worried about him, but I know he’ll win. He’s a fighter,” he said.

Jan Hennop for AFP

Fine wines flourish in Muslim Morocco

Vines stretch to the horizon under the hot summer sun in a vineyard near Casablanca, one of the oldest in Morocco, where despite the pressures from a conservative Muslim society, wine production – and consumption – is flourishing.

“In Morocco we are undeniably in a land of vines,” says wine specialist Stephane Mariot.

“Here there is a microclimate which favours the production of ‘warm wines’, even though we aren’t far from the ocean,” adds the manager of Oulad Thaleb, a 2000-hectare vineyard in Benslimane, 30 kilometres northeast of Casablanca, which he has run for five years.

The social climate in the North African county is less propitious, however, with the election of the Islamist Party of Justice and Development in 2011, and the fact that Moroccan law prohibits the sale of alcohol to Muslims, who make up 98% of the population.

In practice though, alcohol is tolerated and well-stocked supermarkets do a brisk trade in the main cities where there is a growing appetite for decent wine.

According to some estimates, 85% of domestic production is drunk locally, while around half of total output is considered good quality.

“Morocco today produces some good wine, mostly for the domestic market, but a part of it for export, particularly to France,” says Mariot.

Moroccan women pick grapes on September 14 2009 at the Ferme Rouge domain in Had Brachoua. (AFP)
Moroccan women pick grapes on September 14 2009 at the Ferme Rouge domain in Had Brachoua. (AFP)

Annual output currently stands at about 400 000 hectolitres, or more than 40 million bottles of wine, industry sources say, making the former French protectorate the second biggest producer in the Arab world.

By comparison, neighbouring Algeria, whose vineyards were cultivated for a much longer period during French colonial rule, produces 500 000 hectolitres on average, and Lebanon, with its ancient viticulture dating to the pre-Roman era, fills about six million bottles annually.

Some of Morocco’s wine regions – such as Boulaouane, Benslimane, Berkane and Guerrouane – are gaining notoriety.

Already it has one Appellation d’Origine Controlee – controlled designation of origin, or officially recognised region – named “Les Coteaux de l’Atlas”, and 14 areas with guaranteed designation of origin status, most of them concentrated around Meknes, as well as Casablanca and Essaouira.

And in March last year, an association of Moroccan sommeliers was set up in Marrakesh bringing together 20 wine experts.

French legacy 
In the central Meknes region, nestled between the Rif Mountains and the Middle Atlas, there is evidence that wine production dates back some 2 500 years.

But the industry was transformed during the time of the protectorate (1912-1956), when the kingdom served as a haven for migrating French winemakers after the phylloxera pest decimated Europe’s vineyards around the turn of the 20th century.

As in Algeria and Tunisia, the French planted vineyards extensively, with Morocco’s annual production exceeding three million hectolitres in the 1950s.

The main grape varieties used to produce the country’s red wines are those commonly found around the Mediterranean, such as Grenache, Syrah, Cabernet-Sauvignon and Merlot.

Mariot, the manager of Oulad Thaleb, boasts that the domain, which he says has the oldest wine cellar in use in the kingdom, built by a Belgian firm in 1923, produces one of Morocco’s “most popular wines”.

Standing by a barrel, he casts a proud eye on the vintage, describing it as a “warm and virile wine”.

Abderrahim Zahid, a businessman and self-styled “lover of fine Moroccan wines” who sells them abroad, says the country now produces “a mature wine which we can be proud of”.

A man pours wine into a glass inside a wine cellar in the Moroccan town of Benslimane in the Casablanca region. (AFP)
A man pours wine into a glass inside a wine cellar in the Moroccan town of Benslimane in the Casablanca region. (AFP)

Morocco’s wine industry now employs up to 20 000 people, according to unofficial figures, and generated about $170-million in 2011.

But the remarkable progress made by the sector in recent years has taken place within a sensitive social environment.

While alcohol production is permitted by state law, and supermarkets and bars enforce no special restrictions on Muslim customers, officially the sale and gift of alcoholic drinks to Muslims is illegal. They are unavailable during Islamic festivals, including throughout the holy month of Ramadan.

Separately, the Islamist-led government decided last year to raise taxes on alcoholic drinks from 450 dirhams ($53) per hectolitre to more than 500 dirhams.

So far this has not noticeably deterred consumption among Morocco’s population of 35 million, although economic realities certainly influence local drinking habits.

The wine favoured by Moroccans is a cheap red called Moghrabi, which comes in plastic bottles and costs 30 dirhams (about $3.50) a litre.