Saturday, 2 May 2015

SS: The reality of living with Sickle Cell Anaemia



I know when a lot of people hear the initials SS or the full name Sickle Cell Anaemia, they will flinch, some will raise eye brows and others will be gripped with worry, concern or some other form of anxiety. And if some day they are told they are SS they will certainly freak out, wondering what society will say, how they will be treated by their peers, friends, colleagues, etc.
But why is this so?
Sickle Cell Anaemia (SCA) also known as Sickle Cell Disease (SCD) a genetic disease which affects mostly people in Africa and in the West Indies and or people with genetic backgrounds from these parts, has often been looked upon as a mystery disease; with some tribes attributing it to sorcery, others treating the children born with it with suspicion or distaste. So many clichés about the disease which are not true but which over the years have been spread around and accepted by the public as true.
So what exactly is Sickle Cell? 



Sickle-cell disease (SCD), also known as sickle-cell anaemia (SCA) and drepanocytosis, is a hereditary blood disorder, characterized by an abnormality in the oxygen-carrying haemoglobin molecule in red blood cells. This leads to a propensity for the cells to assume an abnormal, rigid, sickle-like shape under certain circumstances. Sickle-cell disease is associated with a number of acute and chronic health problems, such as severe infections, attacks of severe pain ("sickle-cell crisis"), and stroke, and there is an increased risk of death.
Sickle-cell disease occurs when a person inherits two abnormal copies of the haemoglobin gene (S), one from each parent. Reason why someone with the full disease is said to be “SS”. Several subtypes exist, depending on the exact mutation in each haemoglobin gene. A person with a single abnormal copy does not experience symptoms and is said to have the sickle-cell trait, otherwise described as being “AS”. In simple terms this means that person has the sickle genes but does not manifest the full disease. But if he or she gets married to another person with “AS” genotype, the chances of them having children with the full “SS” will be 50:50. In the case of someone who is “SS” that is has the full disease, the chances of them getting more if not all their children having the full disease becomes greater if they should marry someone who is either “AS” or “SS”.
One more thing about Sickle Cell which makes the paranoia surrounding it greater is the fact that there is no cure. The only way of preventing the disease is by cutting off the “S” or sickle cell genes off a patient’s generational bloodline by marriage with sickle cell free people; those described in the medical term as being “AA”.  This is the reason why an electrophoresis is required prior to marriage to permit would be spouses to avoid getting married to someone who has the AS or SS genes like them.

The fact that the disease is hereditary and that there is no cure,  should not be a call for alarm. In fact, children born with the disease can have normal healthy lives with the right amount of exercise, good feeding, proper rest and drinking of lots of water. Children or people leaving with sickle cell are just like any other person who gets a cough or a cold. Their disease is not contagious and having it does not affect their ability to work or study in any way. In fact a lot of children with this disease are most often very intelligent. 
I know at this point a lot of readers will wonder why I say having sickle cell should not be considered as a fatality, what makes me an expert? Well, my reason for saying so is this is that for over 30 years I have lived with the disease as I was born with it.

Reading all about the disease above would make many people wonder why someone with a disease lots of people are yet to understand come out in the open and write about it. But to me writing this piece is to get people, parents, friends, colleagues to know that being born “SS” does not make people with the disease any different from any one else but also to sensitize the public on how to react when confronted with others in their entourage diagnosed with sickle cell anaemia.
My encounter with the disease started back in my primary school days when I, two of my brothers and an elder sister where diagnosed with the full disease while one brother and another sister had the genes but not the disease. Then very little was known of Sickle Cell and a family like mine with four children having the disease was considered a huge misfortune.
The good thing is my parents never let that weaken their resolve to make us exemplary citizens. Being pedagogues, with very strict principles, my parents taught me and my siblings that we were not different from any other children despite the finger pointing at school. We were trained to earn everything we had. We were taught that hard work pays; at a very young age I learnt how to do things lots of normal children my age would not like doing. I went to the farm on holidays, cultivated cassava, melon, yams, plantains just to name a few and during school days I walked to school. Most times the distance was very long but I walked at my own pace and as my strength will permit me too not because there was no car, but because it was part of my upbringing.
The hard parts of living with the disease were the periods when I got malaria and that triggered intense pains in my bones, particularly around the joints. Having a C-shaped red blood cell instead of a circular one meant that during such crisis my red blood cells will not normally move as a circular red blood cell will and these were the moments of horror for me.  Those where the times when I learnt to develop a strong faith, in myself, in God. At a very young age I learnt how to have a strong will, and keep a positive mind frame. Being fearful never did anyone any good, not even to none sickle cell people.
The moments of illness where very expensive then and living in a country like Cameroon where health care is still very expensive and access to good medical care a problem, my parents learnt to prioritise on our feeding. Good feeding made up of lots of fruits, vegetables and lots of water. That in addition to the constant intake of Folic acid, proper rest and little stress and strain kept all four of us alive and well until the day one of my siblings died as a result of medical negligence. One secret about people like me with such a genetic disease is that we should never be administered glucose as drip. When an “SS” patient gets ill, their health record needs to be reviewed by the doctor they consult. In most cases it is advisable for them to have a specialist who knows their health history, in this way errors that can be fatal are avoided.
I remember there were days when the money was there to buy the drugs we needed but the drugs were not available because the roads were too bad and the cars bringing medical supplies could not reach the hospitals or pharmacies in the towns we were living in. Those where scary moments when I came close to death more than once but also when having parents who did not give up paid off. But presently new innovation in technology and new medical research has made health care for people leaving with “SS” a little less expensive.
For me the worst part of living with the disease was the treatment I got from some of my school mates especially while in primary and secondary school. The isolation, the taunts and later on the analysis by prospecting husbands and their families who would cross examine me as if my having sickle shape red blood cells automatically ticked me off the marriage charts. But I learnt to soar above all these.
Presently as an adult, and a journalist, I look back at those moments and realise they made me who I am now. Hard working, strong with experiences that I now share with others, for them to understand their children or sibling or friends are not witches or wizards as some people will want them to belief and they are not misfits either. They just have red blood cells that have a different shape than that of others, period.
Like any other person with rights, they need to be loved, to be believed in, to be given a chance to work, to go to school,  to be treated with respect by their peers or school mates, friends and family. They like anyone else are part of Cameroon’s future, they are future leaders and their ability to be that has nothing to do with the type of red blood cells they have but rather the kind of chances and opportunities given to them by those around them.

Thursday, 22 May 2014

Africa and Global trends of the 21st century: Challenges and Opportunities



The Arnold Bergstraesser Institut, University of Freiburg, Germany
Dr. Christopher Fomunyoh
Africa and Global trends of the 21st century: Challenges and Opportunities
Monday May 12, 2014



I would like to thank ABI for giving me the opportunity to discuss a topic that is dear to my heart, namely: how Africa is coping with the many global trends of the 21st century. I cannot tell you how honored I am to be here at ABI, a highly respected institution with a very impressive research curriculum and a broad international outreach that guarantees considerable attention to pressing international issues, attracting in the process a lot of international students and practitioners. ABI's integrative approach that combines scientific research, applied development research, and the training and further education of development experts values the kind of opportunity we have today where a practitioner like me can reflect and share ideas with you all on global trends affecting the continent of Africa.
First let me provide some context by discussing Africa's contribution to the world.
According to the Population Reference Bureau, as of 2013, the total population of Africa is estimated at 875 million, representing approximately 15% of the world's population. According to a recent study by the Pew Research Center (Feb. 2014), it is projected that by 2050 the population of Africa would have more than doubled and hence increased the most globally to make up a greater share of the world's population. Around 40 percent of the population in most sub-Saharan African countries is below 15 years old. In countries such as Mali and Uganda, close to 50 percent of the population is in the below 15 years old bracket compared to only 20 percent in the USA and approximately 13 percent for Germany. Africa is therefore a youthful continent.
Africa remains a viable trading partner. Undeniably, a German-African       partnership would be mutually beneficial as industrialization remains     a priority for many African governments even if the surge in Chinese interest         in Africa has flooded      African markets with cheap products that      have in many  cases (such as Northern Nigeria and      Zambia) stifled the      nascent private sector in the   textile  industry.         
Germany has been, and remains, one  of the  most important bilateral partners for sub-Saharan Africa.      Moreover, a sizeable share of German development assistance today supports regional integration and capacity building.
Between 2002 and 2012, the imports from Germany to sub-Saharan Africa increased by over 133 percent, going from $100 billion to over $350 billion. Exports from the region to Germany have also risen by a similar magnitude. The top three export categories from Germany to Africa are machinery, manufactured goods and chemicals. Germany has, over time, increased its imports of fuel-based commodities from Africa. Indeed, the top three imports from Africa into the German market are fuel - which represents over 75 percent of all imports - agriculture commodities and some manufacturing.[1]
Africa therefore remains a viable trading partner with a multiplicity of untapped mineral resources. For example, Guinea Conakry with a population of 12 million people is the world's second largest producer of bauxite and has rich deposits of diamonds and gold. In bauxite production, Guinea comes after Australia, but at the same time, Guinea maintains the highest bauxite reserves in the world far ahead of Australia. Ghana and South Africa figure prominently among the top ten gold producing countries in the world. Five African countries - Cote d'lvoire, Ghana, Nigeria, Cameroon, and Togo - are among the top 10 world producers of cocoa. Five others - Ethiopia, Cote d'lvoire, Uganda, Cameroon and Togo - are among the top ten world producers of coffee. Gulf of Guinea countries that include Nigeria, Gabon, Congo Brazzaville, Equatorial Guinea and Angola, account for close to 20 percent of oil imports into the United States; and new technology in oil exploration and production is contributing to new oil discoveries in countries such as Mauritania, Chad, Ghana, Cote d'lvoire, Uganda, Kenya, Tanzania, Mozambique, and even Niger.
Take a look at the mineral map of the DRC - cobalt, coal, natural gas, nickel, diamonds, gemstones, gold, water resources for hydro-electric purposes, just to name a few. These       rosy stories of macro-economic trends and economic potential on the African continent can also be amplified by some of the gains with regards to democratic transitions in the last two decades.
Since the late 1980's and the advent of the third wave of democratization ushered in after the collapse of the Berlin Wall and the end of the Cold War, Africa witnessed   the   achievement   of   independence by Namibia in 1989/1990, the end of apartheid in South Africa and release of Nelson Mandela in 1991, and the fall of many military and autocratic regimes.
In fact, in 1990, Freedom House, which ranks freedoms around the world, rated only four African countries as partially free or democratic. Today, Freedom House rates about 11 African countries as totally free and another 19 as partially free, for a total of about 30.
In 1990, only three African Heads of State had relinquished political power and still lived in their countries -Julius Nyerere of Tanzania, Sedar Senghor of Senegal, and Ahmadou Ahidjo of Cameroon. Today, over 40 former African Heads of State live on the continent, many of whom either voluntarily relinquished power, were term limited in newly adopted progressive constitutions or lost presidential elections and accepted the outcome; thereby facilitating the renewal of political leadership in their respective countries.
In today's Africa, unlike two decades ago, civil society is vibrant and seeks to play an advocacy role; human rights organizations exist and regularly denounce the gross violations of human rights by the dozen or so remaining autocratic regimes; and independent media that includes community-based radio stations and print media provide opportunities for diverse viewpoints and dissenting voices to be heard.
In today's Africa, women are increasingly demanding, and obtaining, the right of access to elective office. The proof is that today in Africa; we have three women heads of state -- in Liberia, Malawi, and the Central African Republic -- with the elected chair of the African Union Commission also being a woman.
Indeed, many African countries have made considerable progress in the past two decades:
·         Renewal of political leadership
·         More credible and transparent elections
·         Emergence of Independent National  Elections Commissions
·         Vibrancy of domestic observers' groups
·         Emergence of new institutions with charters that emphasize the rule of law, democracy and good governance (ex of the AU Charter of 2007) and sub-regional entities such as ECOWAS, IGAD and SADC with protocols, which expand markets by allowing for free trade and free movement of persons and goods.
Bottom line: Africa is not a poor continent. Indeed, it is a rich and wealthy continent both in human capital and natural resources; but it is the poor management of these resources that causes extreme poverty on the continent, and an ever expanding gap between the rich and the poor.
And, yes, in still too many African countries, the rich in many cases are not young, dynamic, hardworking entrepreneurs; but rather old corrupt autocrats and their cronies who feed from the public treasury and exacerbate the levels of corruption.
So the rosy picture pointed earlier does not tell the full story of today's Africa. A lot is still desired of Africa's political leadership as the continent continues to struggle with bad governance, violence and armed conflict   that   destroy   human   lives   and   dilapidate material resources. At the same time, the continent is now being exposed to other emerging global threats such as terrorism and climate change, which it is ill­ prepared to tackle single-handedly.
1.         Conflict
In sub-Saharan Africa, trends show that inter-state conflict has been declining whereas intra-state conflicts have been on the rise. Between 2002 and 2005, the number of state-based conflicts in sub-Saharan Africa dropped by 60 percent. However, in 2005, more than 50 percent of the world intra-state conflicts occurred in Africa, even as that represented a sharp decline in the number of wars since the 1990s. (UCDP/Human Security Database)
As we  see more intra-state conflict, the nature of conflicts has changed to become more asymmetric. Increasingly, the lines between criminal and            political violence are   becoming blurred. Whether it is          in Somalia, South Sudan, Darfur, CAR, Northern Mali or the DRC, conflicts are becoming more fragmented with an increasing number of non-state actors  involved  in conflicts, often moving across what we all know to be very porous national borders. There is a growing and disturbing convergence and connection between networks of organized crime, drug trafficking, illicit activities, money laundering, kidnapping, and terrorism.
Violence directly associated with elections has increased along with the rise in political contestation before, during and after polls, especially in settings where the commitment of political elites to democracy is weak, as illustrated by elections in Zimbabwe in 2005 and 2008 (200 casualties, tens of thousands displaced) then Kenya in 2007 (with over 1,000 deaths), in Nigeria in 2011, and Cote d'lvoire in 2011 with over 3,000 deaths and close to one million internally displaced.
These examples speak to the perpetual latent conflict and tensions that surround political competition and the management of political power in still too many African countries. The tendency by some political elites to view elections as a zero-sum game or "winner take all" and to arrogate to themselves all levers of political and economic control causes  frustrations that often burst to the      surface in violent manifestations or attempts to seize power through non-democratic means.
In post-conflict situations, elections are crucial for choosing who will obtain the legitimacy to govern. In many of these environments, nascent and still fragile governments have to tackle grievances that relate to national reconciliation, unemployment, ethnic marginalization, as well as access to livelihood resources, such as land and water. Indeed, there is evidence that in weak states, competition over scarce resources (either because of climate change or access to commodities such as minerals and oil) often leads to violence. In 2010 and 2011, conflicts over resources accounted for approximately 35 per cent of all conflicts in sub-Saharan Africa.[2]
There is no doubt in my mind that while the youthful population of Africa is an asset, the high percentage of youth in poverty increasing the risk of conflict, particularly when young people lack opportunities for gainful employment or to lead meaningful lives.





2.         Terrorism
Since the last decade, African countries are being challenged by transnational terrorist groups that seek to use certain regions of the continent, notably the Sahel and the Horn, as launch-pads for attacks against domestic and international targets in the name of religious extremism. In many ways, the terrorism threat in Sub-Saharan Africa, which has flared up in recent years has benefited from certain global conditions such as:
·         the emergence of extremist ideologies, exploiting social media and easily accessible information sharing environment with Djihadism from the Middle East trickling over into Africa, and the proliferation of light weapons across the porous continent after the first phase of the Libyan crisis and overthrow of Moummar Kaddafi, and the djihadist explosion in Northern Mali and Boko Haram in North Eastern Nigeria.
It is common knowledge that al-Qaeda in the Islamic Maghreb (AQMI) was launched initially by elements that fought to overthrow the Algerian government in the early 1990s, but in recent years, have consolidated their activities across the Sahel region, particularly in northern Mali. More recently, the emergence of Boko Haram in North Eastern Nigeria is having a devastating impact            on neighboring countries such as Niger and Cameroon.
In the same manner, the activities of Al-Shabaab in Somalia are likely to also destabilize Kenya and other countries in the Horn and East Africa.
It is to be noted that failing economic development; high youth unemployment; deindustrialization (in Northern Nigeria, Boko Haram); limited education and training opportunities; and low access to participation in governance provide the breeding ground and swamps in which these extremist groups thrive. Collectively, as the world fights these groups, we must also focus on draining these swamps.




3.         Governance
Africa is still plagued by issues of corruption, lack of credible political transitions, and marginalization of its poorest communities. Without effective political leadership and the appropriate delivery of services to citizens by the state, the prerequisites for development would never be met, and the Millennium Development Goals would remain a distant illusion. To have sustained economic growth, Africa needs inclusive economic institutions and viable political systems capable of creating an enabling environment for private sector investments and exercising proper oversight. In short, it is not just about having a nation state in name, but, more importantly, today’s debate should particularly be about how the state is governed.
·         Autocratic regimes (Zimbabwe, Cameroon, Burkina Faso)
Countries that have had the same leader for close to three decades or more, coupled with a one party dominance and a weakened opposition - such as Cameroon (32 years), Burkina Faso (27 years), Zimbabwe (34 years), Equatorial Guinea (35 years), and Angola (35 years) - these regimes create conditions for political decay and stifle opportunities for the renewal of political leadership. Although these regimes sometimes put on national elections to mirror               the existence of democracy, the distinction between genuine democracy and the facade that is frequently displayed is quite apparent.
·         Constitutions   without constitutionalism (Burundi, Burkina Faso, Algeria, DRC)
Many political transitions in Africa fail because incumbent heads of states try to retain political power for life or in perpetuity and at all costs. They therefore manipulate   the   constitutions   of   their   respective countries to extend their mandates indefinitely.  If the constitution, which should be the bedrock or foundation of every society can be manipulated at will, the enforcement of any other laws or regulations (and processes or systems) fails in comparison. Even private investors then   would    worry    that   the    rules   on commercial transactions and other engagements could be changed at the whims of one man or of a tiny circle of oligarchs.
Often, these actions gravely frustrate the democratic aspirations of the younger generation of Africans. In some cases, these leaders hold flawed elections that invariably lead to violence and conflict: Zimbabwe (2008) Kenya (2007) Cote d'lvoire (2010). Invariably, a government with questionable' legitimacy is less likely to build the national consensus needed to deliver effective social services to citizens and generate or sustain long-term economic growth and development. On the contrary, such a government devotes public resources to sustaining a system of patronage, prebendalism and corruption, without which its stay in power becomes tenuous.
·         Non-inclusive politics
Unfortunately, in many African countries, the politics of exclusion remains a reality of daily life. Apartheid may have collapsed in South Africa in the 1990's, but in many an African country, identity politics buttressed by subjective elements such as ethnicity, region of origin, and in a few cases religion, deprives many African countries of the expertise and experience of some of the best of their fellow citizens.
Many groups are still marginalized or disenfranchised, especially women and youth. Poor governance is notably acute in post-conflict societies where political leadership is weak and ineffective, and issues such as disarmament, demobilization, reintegration of armed groups, national reconciliation and economic reconstruction are not being dealt with. No wonder then that the recovery period can be long and painful in countries such as Angola and the DRC, or that countries relapse into conflict because they haven't come to closure with the past to avoid further conflict as we now see in South Sudan.




4.         Conclusion
Despite this list of challenges, I see several opportunities for tomorrow’s Africa, and my optimism for      the continent’s future        is unwavering. Let me conclude by pointing to two areas that I believe will determine,            significantly, the wave of the future for Africa.
Youth and technology                                                                       
Today’s era of globalization has witnessed a boom of new technologies. Financial flows together with innovation create markets that foster growth; and one of the biggest growing sectors on the continent is the information and communications technology sector (ICT).
In 2014, several reports indicate that, globally, investments in the ICT sector will increase only in Africa. Countries such as Kenya, Ghana, Rwanda, Tanzania, South Africa and Nigeria, have made huge investments in ICT infrastructure working in partnership with international agencies, ICT vendors and researchers. This is no surprise, as Africa is also home to 200 million youth between the ages of 15-24; a number that could double by 2045 according to the African Development Bank. This age group is the biggest consumer of technological goods, and as they grow in numbers, so does the demand in this sector. The demographics are a real asset for Africa.
The new generation of young Africans being more tech­ oriented and tech-savvy, are poised to contribute meaningfully to positive changes to the development trajectory of Africa, thereby stimulating gains in human development, economic growth and citizen advocacy and participation in politics. This next generation of Africans looks at the world from a more global vantage point with less cumbersome constraints and pressures from traditional reference points.




Migration and the role of the diaspora
Young Africans are extremely mobile often traveling to North America, Asia, and Europe for further       studies or to pursue private professional career opportunities. The human resources and strategic potential of the African diaspora needs to be harnessed to promote responsible, transparent, accountable and democratic systems of governance on the continent. There is the size and positive developmental impact of financial remittances, but equally important to note  that the African  diaspora  portents non-financial  attributes that should be leveraged to influence positively on the development of their homelands, and significantly contribute to improving lives on the continent (Ex. Somalia, Peace- and state-building programs in Somalia). Nothing should be allowed to stop the African diaspora from contributing to democratic governance in much the same way that they currently contribute to economic welfare and development in their home countries. They can do so by making their knowledge, practical experience, professional expertise, and transnational relationships available for strengthening the capacity of political institutions.
One cannot forget the historic role of the first wave of the African diaspora when it returned to the continent in the 1950's and early 1960's to join the struggle for independence. One must remember that leaders such as Kwame Nkrumah who became president of Ghana - the first country in Sub-Saharan Africa to win independence; Nnamdi Azikiwe of Nigeria who launched  the  first political  party in West Africa (the National Council of Nigeria and the Cameroons); Sedar Senghor   of Senegal, Houphouet Boigny of Cote d'lvoire; Ahmadou Ahidjo of Cameroon - who became the first post-independence presidents in francophone Africa after serving in French institutions in Paris; Tom Mboya of Kenya who studied at Oxford University and went back to lead negotiations with the British over the independence of Kenya; and many other Africans of that generation played significant roles that remain a legacy of political and visionary leadership on the continent. Today's diaspora must be ready to take on the mantel, for that too is required in shaping the destiny of Africa in this 21st century.
Thank you for your time and attention.
Dr. Christopher Fomunyoh
Senior Associate for Africa
National Democratic Institute for International Affairs (NDI)



[1] Vera Songwe, April 3, 2014, The EU-Africa Summit: Why Germany Should Take Center Stage, available at: http://www.brookings.edu/blogs/africa-in-focus/posts/2014/04/03-germany-european-union-africa-summit-songwe
[2] The future of intrastate conflict in Africa: More violence or greater peace?, Jakkie Cilliers and Julia Schünemann, Institute for Security Studies, ISS paper 246, May 2013, p.4. Available at: http://www.issafrica.org/uploads/Paper246.pdf