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‘No One Loved Me – Not Even God’

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When Irene Nkosi took to the stage at a glossy Moms+SocialGood event in New York recently, it was hard to pair the confident woman in a striking, Swazi-inspired dress with her tragic story: “By the age of 16, not really even a woman yet, I was a parent. I was also a victim of rape and my attacker was never jailed,” Nkosi told the stunned audience.

She went on to say how – after the birth of her second child – she was diagnosed with HIV.

“Now I was sure no one loved me – not even God.”

Nkosi, from Bronkhorstspruit, on the border between the Gauteng and Mpumalanga provinces in South Africa, said the clinic didn’t educate her about HIV “or how to prevent my baby from infection”.

“I was heart-broken and frustrated. I feared for my life and the baby I was carrying.”

Hoping for support after sharing her status with family and neighbors, she was instead isolated and called names. Although she gave birth to an HIV-negative baby, it died after being smothered by a blanket. Nkosi believes crèche staff neglected her baby because of her own positive status.

Nkosi’s story took me back to 2005, to Chris Hani Baragwanath Hospital in Soweto, South Africa, where I was researching the challenges faced by HIV-positive, pregnant women for a Media Fellowship on HIV at Wits University’s Journalism School.

The stories those women told were just as heartbreaking.

Most of the women I interviewed were following the correct antiretroviral regimen to prevent HIV transmission to their babies, but for some it was too late. Almost all of them carried the terrible burden of stigma and rejection by their families, partners and communities. Often, they were “outed” after feeding their babies the free government-issue formula milk in its distinctive orange tins to prevent HIV transmission. They would tell elaborate lies to explain why they were not breastfeeding.

“My grandmother forced me to breastfeed. I told her my breasts were dirty, the nipples were cracked. Then I just take a razor blade and then I just cut… and I tell her that there is blood in my breast, it is not good to breastfeed,” one woman told me.

Another I interviewed had been hounded out of the house by her mother and sisters and forced into a shelter. One frightened young mom said she had been too scared to disclose her status at a hospital in KwaZulu-Natal and now had an HIV-positive baby. Several told me that their partners had rejected them and blamed them for “bringing the disease into the house”.

I can only hope that the lives of those women and their children have improved since then. But, more than a decade later, what are the prospects for the HIV-positive women who are pregnant now?

The big picture is hardly rosy, with an estimated seven million South Africans living with HIV (according to 2015 figures). And it is women and young girls who still carry the greatest burden, with HIV prevalence in women almost double that in men, and with the rate of infection in young women aged 15-24 almost four times higher than in males of the same age bracket. Among certain vulnerable groups like sex workers, HIV rates are sometimes as high as 40-88%, according to the Human Sciences Research Council.

But without a doubt, massive strides have been made in putting people who need treatment onto it (now 48% of all those infected in the country are on antiretroviral treatment) and in reducing HIV transmission from mother to child. According to UNAIDS, more than 95% of the country’s pregnant, HIV-positive women are accessing antiretroviral treatment to prevent transmission to their babies.

In 2011, UNAIDS and PEPFAR (U.S. President’s Emergency Plan for AIDS Relief) launched the Global Plan to lower mother-to-child transmission by 90%. After four years, six priority countries – South Africa, Swaziland, Botswana, Mozambique, Namibia and Uganda – had met this target. Mother-to-child transmission rates in South Africa currently stand at 4%. If the rate of infection is under 5%, the UN considers mother-to-child transmission to be virtually eliminated, since 100% elimination cannot be achieved.

Over the years, the guidelines and treatment for HIV-positive mothers and babies have changed too. Now, the World Health Organization recommends that all pregnant and breastfeeding mothers begin lifelong antiretroviral treatment. And in 2011, the South African government phased out supplying free formula milk in public hospitals and clinics. Unless medical conditions dictate otherwise, breastfeeding is now recommended.

But what of the people behind the statistics, people like Nkosi, and the mothers I interviewed? Nkosi says her life changed dramatically when she came into contact with mothers2mothers, an organization that deserves much credit for helping to reduce transmission rates to babies as well as for improving the health and emotional states of HIV-positive mothers. The organization employs HIV-positive Mentor Mothers to help women access treatment and health services for themselves and their families and bring them out of isolation.

When Nkosi signed up as a mentor for mothers2mothers, her confidence grew daily. Now she is happily married to an HIV-positive man and together they have a four-year-old daughter, Nothando, who is HIV-negative. Their status is out in the open and the children compete to give their parents their daily medication, she laughingly tells me later.

Nkosi ended her short, powerful speech with the following words: “(My children) have a mother who they can be proud of, a woman who was once a victim. But now I can strongly say I’m a survivor.”

Stigma, she tells me, is gradually diminishing. “Even though some people still lack knowledge, in the support group sessions we share our challenges and fears, the problems we encounter in our households. We find out how best we can help each other.”

A mothers2mothers press release captures the organization’s simple but highly-effective approach: “The epidemic may be global but the solution is local.” When marginalized HIV-positive mothers are trained to be healthcare workers in understaffed health centers, and paid for their work, they become role models and leaders in their communities.

The results of this formula have been astounding. Studies showed that women who received two or more mothers2mothers visits were seven times more likely to test their babies for HIV at six weeks, than those who only received one visit. Among their clients, the rate of transmission is only 2.1%. A recent external study in Uganda also showed the model to be a huge money saver by avoiding treatment costs.

Launched in Cape Town in 2001 by Dr Mitch Besser, an American gynaecologist and obstetrician who fell in love with South Africa as a high school exchange student and returned to work there, mothers2mothers started out with five Mentor Mothers. Now it services 860,500 women and families in eight sub-Saharan countries and is partnering with both the South African and Kenyan governments.

In South Africa, mothers2mothers had by 2015 reached close to 51,000 HIV-positive women and 27,800 babies exposed to HIV. The organization also offers early childhood services and HIV counseling, testing and sex education for adolescents, through a peer mentorship program.

Robin Smalley, Co-founder and Director of mothers2mothers U.S., explains why the model is so successful. “If you empower women to take control of their health and their families’ health, they’ll move mountains to do this. We give them the tools to succeed and they do. We are not coming in as outsiders and telling them what they should be doing. We give them the information and employment and let them do what comes naturally, which is to support one another and their children.” Mentor mothers are employed for two years before they phase out, and let others take over.

Smalley’s own involvement with mothers2mothers came about when, in a grief-stricken state, she visited Besser after his sister (her close friend), died unexpectedly after minor surgery. Smalley was so taken by the work that Besser was doing in Cape Town, and the invincible spirit of the HIV-positive mothers she encountered, that she immediately persuaded her family to join her there and began working to grow the organization. Years later she moved back to the US to look after her ageing father and to keep building mothers2mothers’ financial base by lobbying US donors.

Since then, she has been working 24/7 to keep up with the organization’s expansion. Although mothers2mothers has had requests from India, Thailand, Haiti and Central American countries to open up branches there, it is staying focused on sub-Saharan Africa, where the need is greatest. – Written by Philippa Garson

Health

Cure For Counterfeit Drugs?

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Blockchain technology is also revolutionizing supply chains in the pharmaceutical industry, in the process, helping track fake medicines.

From genomics to robotics, technology is truly revolutionizing the healthcare sector. And while it’s easy to become consumed by exciting, futuristic trends like artificial intelligence (AI) diagnosis, digitized patient records and 3D-printed medical tools, technology is also transforming the pharmaceutical industry. How medication is prescribed, dispensed and administered is big business with McKinsey predicting the value of Africa’s pharmaceutical industry to be $65 billion in 2020.

But fake drugs are an ongoing and complex issue – they can cause death, have unknown side-effects, fail to treat illnesses, and sometimes even add to the spread of disease. According to World Health Organization (WHO) statistics, 42% of detected cases of falsified (or substandard) pharmaceuticals occur in Africa – reports estimate that between 72,000 and 169,000 children die each year from pneumonia because of counterfeit antibiotics while fake malaria drugs cause an additional 64,000 –158,000 deaths every year in sub-Saharan Africa. Both antimalarials and antibiotics sit among the most commonly-reported counterfeited drugs.

“Fake medicine distribution is rampant because business processes are siloed between the various industry stakeholders, which puts the industry at risk of fraud,” explains Heidi Patmore, a marketing consultant specializing in technology that’s changing consumer behavior.

“One solution to this would be cross-company process automation which could easily be enabled by a blockchain data interchange. This creates an open information system that all players can use to verify the authenticity of medication because it can track and trace it from when it’s manufactured to when it is dispensed to the patient.”

Companies such as IBM and SAP are working on blockchain solutions to weed out Africa’s counterfeit medication network. When medicine is returned to pharmaceutical manufacturers, for example, it is often re-sold instead of being destroyed. How can a small local pharmacy ensure what is returned is authentic? SAP are working with their existing client base – Merck, GSK, Ingelheim, McKesson and others – on a blockchain project to verify that any returned drugs are original.

IBM Research’s solution for Africa (currently in development in Haifa, Israel) includes a mobile interface and permissioned blockchain backend that enables each certified and authorized party in the network to initiate action, finish their transaction, and track its progress.

“It also includes the monitoring of temperature to ensure compliance with the proper conditions for transportation and asset transfer,” adds Inna Skarbovsky, a blockchain architect from IBM Research – Haifa. “Blockchain ensures full provenance for each medicine package, uniquely identified with a barcode or a serial number. This makes it possible for all authorized parties to track the drugs through the entire supply chain and the drugs’ life-cycle.”

This also allows significant cost reductions by eliminating each participant’s need to manage a separate system for traceability of its components. “It also improves procedural efficiency for change-of-hands, make it much harder for counterfeit drugs to be introduced into the supply chain and to be distributed to end-users,” says Skarbovsky.

Towett Ngetich, CEO of Uthabiti Health, a Kenya-based pharmaceutical company

Towett Ngetich is the CEO of Uthabiti Health, a Kenya-based pharmaceutical company that has implemented blockchain to bring transparency and accountability back to a country where statistics show that 30% of medicines sold are counterfeit. Uthabiti, which means ‘verify’ in Swahili, was started after Ngetich’s first-hand experience with the effects of fake health products: “Back in university, a significant number of students fell victim to unplanned pregnancies and unsafe abortions. With deep research, it was uncovered that there had been a supply of fake contraceptives and backstreet abortion pills into the student market,” explains Ngetich. More findings showed the presence of fake antibiotics, antiretrovirals (ARVs) and non-communicable diseases (NCD) medicines in the Kenyan pharmaceutical supply chain.

“Pharmaceutical science is the center of healthcare – one mistake in any drug composition or formulation has the risk of endangering a significant number of people. The need to access safe, affordable and quality health products in its simplest form means life and death in diagnosed health complications. Blockchain gives patients the ability to track and trace products using attached IDs – it also gives Uthabiti Health the ability to know where all our health products sit within each supply chain,” he says. Uthabiti Health procures medicines from different pharmaceutical manufacturers. Once received, they go to an internal laboratory for quality testing and are then labeled with the product’s safety lab report – attached in their codes is a unique blockchain ID. The medicines are then passed on to their partnering retail points, ensuring that the medicines dispensed to patients can be verified with something as simple as a text message.

“This brings in consumers in safe-proofing the supply chain of pharmaceuticals,” adds Ngetich.

The proliferation of fake drugs throughout Africa is complex – on average, medicine changes 30 hands before reaching the destined pharmacy – but blockchain technology has great potential to help stop counterfeit medicine distribution because it brings traceability and trackability to the entire pharmaceutical supply chain, ensuring the immutability of information. 

Blockchain ethics?

Candice De Carvalho

While blockchain is still a relatively niche technology, it is slowly changing how organizations operate. Blockchain promises better security and transparency, but not necessarily for the customer, in the case of drug allocation: “Where blockchain technology could likely increase efficiency and simultaneously decrease the abuse of medicines, customers benefit. The pharmaceutical and related industries are unique however, in that the ‘consumer’ is also a patient – a vulnerable group with special needs and rights,” explains Candice De Carvalho, the founder of Easy Ethics CPD.

Although overall transparency in the supply chain increases through the use of blockchain, and this confers patient benefits, these must be weighed against patient privacy and confidentiality. 

“With emerging technologies more freely available, we’ve observed an interesting shift in patient behavior, where data privacy is regarded less as an absolute by patients, in favor of a kind of sliding scale, where privacy itself is a currency that purchases medical benefits along the way,” adds De Carvalho. “Patients, for the right benefits, are perhaps more willing to part with some privacy privileges.”

De Carvalho questions the genuine knowledge that patients have of any exposure they experience through their use of novel medical device or systems innovations. The key drivers for the business are not necessarily unified with the total needs of the patient. However, the more the technology owners protect and balance the patient’s need for confidentiality and consent, the more they will ultimately see business benefit. 

“In the context of a doctor-patient relationship, the doctor has a positive duty to enhance patient understanding so that the patient enjoys a truly informed consent. Does this then mean that technology providers are now responsible in the same way that medical health workers are?” she ends.

-Tiana Cline

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Agriculture

Green-Sky Thinking

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In Johannesburg, city-dwellers like Linah Moeketsi have taken the future of sustainable farming into their own hands. Where land is becoming scarce, they look to the skies.


Doornfontein is one of Johannesburg’s older inner-city suburbs with decaying buildings and dingy alleys that wear a dour, monochrome look.

Daily commuters and street surfers jostle with delivery vans and mountains of metal scrap but the grey of the concrete city makes it hard to believe that there could be a patch of green in a most unlikely location.

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Above the humdrum of life here is a rooftop hydroponics farm looking down on the city, but upwards to a new route to restoration and urban preservation.

Atop the eight-floor Stanop building – offering a breath-taking view of the city and the landmark Ponte Towers in the distance – one woman has made it her mission to turn a grimy grey terrace into a green lung on the city’s skyline.

“City life is taking on a totally new direction… even people who think they couldn’t one day farm, find themselves on rooftops,” Linah Moeketsi tells FORBES AFRICA.

Moeketsi grows herbs, used to treat non-communicable diseases (NCDs), in a 250m x 500m greenhouse on the building’s terrace. But her rooftop farm is sans any soil – it uses a hydroponics system.

“I think because we are in the city and we would like to produce for people in the city, hydroponic farming is one of the answers because you can actually harvest more than twice the produce, and the growth rate is quicker and there is produce that you can have throughout the year that people demand because it is in a controlled environment,” she says.

On a windy Wednesday morning in October, we meet Moeketsi at her aerial green facility, a couple of days before she is to send some of her plant produce to the market.

She talks about her journey as an offbeat farmer. It all started when her father fell ill in 2013, when doctors failed to correctly diagnose his disease.

“They couldn’t see that he was diabetic. He didn’t show the signs of diabetes, but he had this foot ulcer that just wouldn’t go away,” she says.

“The future of city farming is great simply because we have more and more young people getting into this space. Even though it’s farming, they are looking at it from a very different angle.

Moeketsi decided to do her own research, so she read up books on African medicinal plants and used some herbs that belonged to her late mother, who had been a traditional healer.

“It took me a good eight months to help my dad and I actually saved him from having an amputation.”

The news of Moeketsi curing her dad’s diabetes using herbs spread. Sadly, her father died in 2016, at the age of 87. But she is proud to have helped prolong his life.

“So he passed away in his sleep, not sick, nothing, he was just old. But he was always grateful; he was like, ‘even when I die, I’m going to die with both my limbs’, so we would make a joke about it.”

READ MORE| Businesses At The Heart Of A Greener Future

After her father’s demise, Moeketsi rented some land and turned her knowledge on natural herbs into a fully-fledged farm. However, when the owner of the land returned, she was forced to vacate.

Land was always going to be a problem in the city. But instead of giving up, Moeketsi looked to the skies.

“Because of this passionate drive for an answer, I found myself researching what’s happening outside Gauteng and South Africa, and I saw in Europe, they were farming on rooftops,” she says.

In 2017, her dream became a reality when she secured a deal with the City of Johannesburg as part of an urban farming program, and started the rooftop project a year later.

When we visit her greenhouse, we are welcomed by the sweet lingering scent of herbs. It’s hot and humid, and two fans whir away to cool the air.

Moeketsi walks around the greenhouse wearing dark glasses and a white jacket, with a syringe in hand – she could easily pass off as a medical doctor.

She elaborates on the hydroponics system. There are four pyramids, each attached to their own reservoirs of water. On each pyramid, different plants, ranging from spinach, lettuce, sage, parsley, basil and dill, rest on beds with pipes connecting them to the reservoirs. Moeketsi plucks out one of the pipes and inserts the syringe; water spouts out of the tube and she returns it to the bed.

“Twice a day, you have to check that water is actually going through the pipes, because that’s how the plants get water and nutrients,” she explains, as she unblocks a pipe using the syringe. She says it’s one of the best ways to farm using little water.

“When you put in certain plants in the greenhouse, you know you are guaranteed sustainable farming because you can produce those plants and harvest them,” she says.

Moeketsi adds that this allows her produce to stay consistent season after season.

“So, from that point of view, it makes the city more sustainable in terms of food produce that is easily accessible and cost-effective for the consumer because not everyone around here can afford the high prices of food but they can at least afford what we sell, whether it is at R10 ($0.5) or R15 ($1).”

As Moekesti continues to tend to the plants, a farmer she works with walks in and begins filling up the reservoirs.

Lethabo Madela has known Moekesti for almost six years.

“When you look around Johannesburg, there is no space, so rooftops have saved us a lot, especially those of us that love farming,” says Madela. “I’m learning a lot and I think she [Moekesti] changed the whole concept of farming for me because I used to farm vegetables. I didn’t know culinary herbs or medicinal herbs.”

Moeketsi speaks of other farmers around the city who have taken to the rooftops to farm plants such as strawberries, lemon balm, spinach and lettuce.

READ MORE| Everything You Need To Know About The Future Of Pesticides And Bees

In a suburb called Marshalltown, a 10-minute drive from Moeketsi’s farm, Kagiso Seleka farms lemon balm also using hydroponics.

He produces sorbet and pesto from his produce which is then used to make ice cream.

“It [hydroponics] is great for farming sensitive plants in terms of temperature. Lemon balm does not like frost. But it’s better to grow even out of season so you can set a higher price,” he tells us.

However, he says hydroponics farming is a luxury not many farmers can afford.

“It [hydroponics] does have a bit of a higher capital upfront, but you get a higher yield and higher quality, so people are willing to pay more. Hydroponic planting saves about ninety five percent of water soil farming in a water-scarce country,” says Seleka.

READ MORE| Local Solutions Can Boost Healthier Food Choices In South Africa

“We do have water shortages, and I know people are on the whole ‘organic trip’ but, is it more important to have an organic plant versus a water-saving environment?”

The Program Coordinator for Agriculture at the City of Johannesburg’s Food Resilience Unit, Lindani Sandile Makhanya, says there certainly are more rooftop farmers in Johannesburg now than ever before.

Converting idle terraces into avenues of profit is becoming a norm. There are new rooftop farms being set up every day, offers Makhanya.

He regularly visits Moeketsi’s farm to check on the progress and collect produce to sell.

“Urban farming in Johannesburg is rising, mainly because the idea of producing our own food is very important because most people are moving to urban areas and therefore it stands to reason that we have to try to produce as much as possible,” says Makhanya.

“[There is growth] even in animal production, although we are moving away from the bigger numbers, but we are involving the smaller ones; because of the space issue, they are increasing overall.”

For Moeketsi, her farm has changed her life and given her hope for a better future. In addition to the teas, tinctures, ointments and medicinal products she processes from her plants, she plans to include more by-products such as syrups in the future.

“The future of city farming is great simply because we have more and more young people getting into this space. Even though it’s farming, they are looking at it from a very different angle,” she says. “That is why the city is changing and rooftop farming is going to get bigger and bigger.”

Clearly, farming in Africa is covering exciting new ground.

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Health

How Virtual Therapy Apps Are Trying To Disrupt The Mental Health Industry

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Millions of Americans deal with mental illness each year, and more than half of them go untreated. As the mental health industry has grown in recent years, so has the number of tech startups offering virtual therapy, which range from online and app-based chatbots to video therapy sessions and messaging. 

Still a nascent industry, with most startups in the early seed-stage funding round, these companies say they aim to increase access to qualified mental health care providers and reduce the social stigma that comes with seeking help. 

While the efficacy of virtual therapy, compared with traditional in-person therapy, is still being hotly debated, its popularity is undeniable. Its most recognizable pioneers, BetterHelp and TalkSpace, have enrolled nearly 700,000 and more than 1 million users respectively. And investors are taking notice.

Funding for mental health tech startups has boomed in the past few years, jumping from roughly $100 million in 2014 to more than $500 million in 2018, according to Pitchbook. In May of this year, the subscription-based online therapy platform Talkspace raised an additional $50 million, bringing its total funding to just under $110 million since its 2012 inception.

The ubiquity of smartphones, coupled with the lessening of the stigma associated with mental health treatment have played a large role in the growing demand for virtual therapy. Of the various services offered on the Talkspace platform, “clients by far want asynchronous text messaging,” says Neil Leibowitz, the company’s chief medical officer.

Users seem to prefer back-and-forth messaging that isn’t restricted to a narrow window of time over face-to-face interactions. At BetterHelp, founder Alon Matas notes that older users are more likely to go for phone and video therapy sessions, whereas younger users favor text messaging.

“Each generation is getting progressively more mobile-native,” says John Prendergass, an associate director at Ben Franklin Technology Partners’ healthcare investment group, “so I think we’re going to see people become increasingly more accustomed, or predisposed, to a higher level of comfort in seeking care online.”

The ease and convenience of virtual therapy is another draw, particularly for busy people or those who live in rural areas with limited access to therapy and a range of care options.

Alison Darcy, founder and CEO of Woebot, a free automated chatbot that uses artificial intelligence to provide therapeutic services without the direct involvement of humans, says that with Woebot and other similar services, there is no need to schedule appointments weeks in advance and users can receive real-time coaching at the moment they need it, unlike traditional therapy. The sense of anonymity online can also lead to more openness and transparency and attracts people who normally wouldn’t seek therapy.

Along with stigma, the cost of therapy has historically acted as a barrier to accessing quality mental-health care. Health insurance is often unlikely to cover therapy sessions. In most cities, sessions run about $75 to $150 each, and can go as high as $200 or more in places like New York City. Web therapists don’t have to bear the expense of brick-and-mortar offices, filing paperwork or marketing their services, and these savings can be passed on to clients. 

BetterHelp offers a $200-a-month membership that includes weekly live sessions with a therapist and unlimited messaging in between, while Talkspace’s cheapest monthly subscription at $260-a-month, offers unlimited text, video and audio messaging.

But virtual therapy, particularly text-based therapy, is not suitable for everyone. Nor is it likely to make traditional therapy obsolete. “Online therapy isn’t good for people who have severe mental and relational health issues, or any kind of psychosis, deep depression or violence,” says Christiana Awosan, a licensed marriage and family therapist. 

At her New York and New Jersey offices, she works predominantly with black clients, a population that she says prefers face-to-face meetings. “This community is wary of mental health in general because of structural discrimination,” Awosan says. “They pay attention to nonverbal cues and so they need to first build trust in-person.”  

Virtual therapy apps can still be beneficial for people with low-level anxiety, stress or insomnia, and they can also help users become aware of harmful behaviors and obtain a higher sense of well-being. 

Sean Luo, a psychiatrist whose consultancy work focuses on machine learning techniques in mental health technology, says: “This why some of these companies are getting very high valuations. There are a lot of commercialization possibilities.” He adds that from a mental health treatment perspective, a virtual therapy app “isn’t going to solve your problems, because people who are truly ill will by definition require a lot more.”

Relying on digital therapy platforms might also provide a false sense of security for users who actually need more serious mental-health care, and many of these apps are ill-equipped to deal with emergencies like suicide, drug overdoses or the medical consequences of psychiatric illness. “The level of intervention simply isn’t strong enough,” says Luo, “and so these aspects still need to be evaluated by a trained professional.

Ruth Umoh, Diversity and Inclusion Writer, Forbes Staff.

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