People carry some ailments for decades before symptoms manifest and it’s too late for treatment. Those who do get diagnosed must grapple with expensive medical costs. What then is the solution?
How do you test for a virus when you don’t know you have it?
Hepatitis B is one such. Often times, it remains undetected until it is viral, at which stage, it is often too late.
It leads to an infection of the liver that can cause both acute and chronic disease. When chronic, it attacks the liver, eventually causing scarring (cirrhosis) of the organ, liver failure, and cancer.
There are various types of hepatitis viruses including types A, B, C, D and E. Types A, B, and C are the most common. All five hepatitis viruses can cause acute disease, but the highest numbers of deaths result from liver cancer and cirrhosis that occur after decades of chronic hepatitis B or C infection.
According to the World Health Organization (WHO), an estimated 257 million people are living with the hepatitis B virus (HBV) infection, however, the rate of diagnosis is extremely low, at approximately 9% of all HBV-infected persons.
In February, Abbott Laboratories announced, “the world’s most sensitive rapid diagnostic test for the detection of hepatitis B surface antigen… This highly-sensitive, easy-to-use, rapid lateral flow test enables identification of those with the virus and facilitates linkage to care in every healthcare setting”.
This is a monumental victory for healthcare practitioners, who are working on the ground to eradicate the virus, says Dr Andrew Scheibe, a medical doctor who focuses on HIV, viral hepatitis and infectious diseases among key populations, specifically people who use narcotics.
“What’s useful about it is that it’s very easy to use and you get results in 15 minutes. Compared to the previous test, you’re able to detect more people who are infected… [as] it detects more hepatitis B surface antigen (HBsAg) in the blood… this is very useful in the field as it is a rapid test,” he says.
Scheibe is a senior technical advisor for TB and HIV Care and has research affiliations with the University of Pretoria’s Department of Family Medicine and the Urban Futures Centre at the Durban University of Technology.
The rapid diagnostic test by Abbott Laboratories is likely to empower health practitioners to fight a battle that has seemed insurmountable on the continent.
A report released by WHO states that the organization “has set baseline targets to diagnose 30% of HBV-infected individuals by 2020 and 90% by 2030. In order to reach these targets, rapid testing is imperative. Testing and diagnosis of HBV is the gateway for access to both prevention and treatment services and is a critical component of an effective response to the hepatitis epidemic”.
From an economic perspective, it is imperative that hepatitis B mortality rates be reduced because a significant number of the people who become symptomatic manifest from middle to late life.
“Those are people who should be economically active, so that has a huge economic consequence. And the treatment of people who have liver failure is very expensive,” Scheibe says.
In sub-Saharan Africa, the overall hepatitis B carrier rate in the general population is 5%-20%, which is amongst the highest in the world. Viral hepatitis is also a growing cause of mortality among people living with HIV.
“About 2.3 million people living with HIV are co-infected with hepatitis C virus and 2.6 million with hepatitis B virus,” according to WHO.
There are other socio-economic factors that make the virus endemic in sub-Saharan Africa, these are dictated by lack of basic resources, as well as population density.
“A lot of the factors are linked to socio-economic and environmental factors. With hepatitis B in particular, it’s transmitted through bodily fluids, so if there aren’t good personal and public hygiene practices, that can foster an environment where these infections are spread,” Scheibe says.
“If you are in an area where there’s a high population living with an infection, it means that the likelihood of people contracting it is higher… This is a concept we call the community viral load. If, in sub-Saharan Africa, there already is a lot of hepatitis B, people will automatically be at a higher risk of contracting it, because they are more likely to come into contact with people who have the infection.”
The virus is transmitted through contact with the blood or other body fluids of an infected person.
“The virus is a hundred times more infectious than HIV. It’s one of those conditions that people can live with without knowing they are infected… a proportion of those people will go on to develop live cancer, which we have few treatments for,” Scheibe says.
In South Africa, the lack of political will to meet the goals set out by WHO has been criticized by medical practitioners who feel dealing with the virus decisively would be beneficial for all.
“I think a lot of work needs to be done to get government to put it on their political agenda, particularly, if it’s affecting people who are at high-risk, that government may not want to deal with.
“For example, [these are] men who have sex with men, sex-workers and people who take drugs. In many contexts, those are politically sensitive topics, but it would be very important for government to embrace,” Scheibe says.
Happy Phaleng, the MSM (men who have sex with men) Programme Coordinator at OUT-LGBT Well-Being in Pretoria, South Africa, says the rapid diagnostic test serves as a much-needed form of assistance for a queer community that, at times, is not prioritized because of stigma.
Phaleng, who was vaccinated as a result of a study that was taking place at work, says his hepatitis B awareness was scant prior to the vaccination. He says in some cases, people resist getting vaccinated.
“I remember when they started the study, it was quite a struggle to get people vaccinated… You look at things like PrEP (Pre-Exposure Prophylaxis), you still find people who say, ‘let me go think about it,’ even though it’s free and on-the-go.”
However, on the day he meets FORBES AFRICA, he is armed and ready with the hepatitis B and C pamphlets that are laid out in front him as he has a frank conversation about risky lifestyles.
He says there’s a certain demographic of people who are privy to information as a result of being privileged to access, he also says there are cost implications to purchasing certain news items and money is not easy to come by.
“Class plays a role. There’s a certain class of people, in this case, the medical space, who would know about medical developments. Some people don’t read, and those who do, won’t take it in because it doesn’t affect them directly,” he says.
Phaleng also frankly states that people tend to be their own worst enemies as a result of unfounded fears that prevent them from accepting help.
“We are too resistant to new things and we also have the notion that, ‘I’ve lived before without this vaccine. Why am I complicating my life with medications and vaccination?’ This ties in with the concept that, ‘what you don’t know, won’t kill you’.”
Innovations are good and well, however, studies and pilots defeat the purpose of what they are intended for as they are, at times, exploitative and not reciprocal. He alludes to the idea that citizens tend to be treated like guinea pigs by those who work on the ground on fact-gathering missions.
“In South Africa, we have had so many piloted studies and, as people, we get tired… I’ve worked with people who conduct studies can’t enter our communities and urge us to try new things and, the next thing you know, the medication no longer exists because of the outcomes of the study.”
“They just want to use our bodies to get their PhDs and launch their products.”
Scheibe, who has been working in the field of harm reduction and substance use for the past eight years, says that more people in high-risk groups may acquire the infection and they should also be vaccinated.
According to NCBI, these include, but are not limited to, people who frequently require blood or blood products; people interned in prisons; persons who inject drugs; and people with multiple sexual partners.
Duncan Tsegula, who is a peer outreach team leader for the Harmless Project at OUT-LGBT Well-Being, is a recovering drug user who used to share needles while homeless in the streets of Pretoria.
The Project, which has been running for four years, focusses on reducing the risk of harm, with particular focus on homeless (needle) drug users. Tsegula has been a leader for two years.
“Before I became a member, I was a client of the same project. They were giving out needles, to us, guys using on the street. It got to a point where people were discarding them on the street. We came up with a solution which was a needle exchange,” Tsegula says.
“If we give you 10 needles this week, we come back next week to give you more, and you return the old ones. That’s when we are sure that you are not discarding them on the streets. So far, for the past year-and-a-half, it has been working and the city council has stopped complaining.”
He confirms that he’s witnessed people sharing and repurposing needles. Some of the sharing of needles was due to desperation because homeless people are profiled and turned away from many businesses even when they are purchasing products.
“I was one of the people sharing needles. It was not easy to access a needle even if you had money because of the way you look.
“About 12 years ago, when my boss needed a needle to inject, the pharmacy refused him and he eventually broke a window. He was withdrawing and because of anger, he broke a window and was arrested.
“Our project is peer-driven and people who were there and used drugs have links with the clients, so it’s easier for them to communicate with us, but it’s not easy.
Along with the clean needles, the project provides homeless clients with toiletries, condoms, lubricants, showers, haircuts, water, a weekly meal of choice and a weekly movie of choice.
They also provide alcohol swabs to prevent infection when users inject. “Some of the guys go through bins while they collect litter for recycling, they might cut themselves while doing that. The swabs are used to clean the surface area where they are going to inject,” Tsegula says.
Along with drug users, sex-workers are also profiled and are not afforded equal rights.
Phaleng says, “there are many people who take drugs for their own reasons but what we’re saying is, ‘even though you’re using for your own reasons, do it the safe way.’ Because, you can imagine if I’m injecting drugs and I still have that I’m going to – I might infect that person with a range of things.
“Sex-work is work. Everybody has the right to health. They also deserve to be treated fairly and access medication.
“A healthy society is a very productive society. If we get to a point where we succeed in preventing illness rather than treating them, will save large amounts of money,” Phaleng says.
Scheibe echoes his sentiments.
“We must understand that we need to move away from criminalization because that has very negative public health consequences which, in turn, have very negative financial implications.”
For his work with hepatitis, he’s the light at the end of the tunnel, but he is cautiously optimistic.
“It’s important to be optimistic that progress can happen, should happen and is already happening. It’s very clear that we have the tools, and we know what needs to be done.
Scheibe says very little will change, “unless there is a recognition that policies that criminalize sex work and drug use, or are discriminating on women, are re-evaluated. There needs to be a lot of focus in addressing those, or we will never be able to eliminate hepatitis or HIV.”
No Seat At The Global Table For Indigenous African Cuisine
Gastronomic tourism based on African food could easily increase and create new value chains that unlock billions in untapped wealth for the continent, but what is stopping us?
Food and tourism are an integral part of most economies, globally. Food is undeniably a core part of all cultures and an increasingly important attraction for tourists. To satisfy their wanderlust, contemporary tourists require an array of experiences that include elements of education, entertainment, picturesque scenery and culinary wonders. The link between food and tourism allows destinations to develop local economies; and food experiences help to brand and market them, as well as supporting the local culture and knowledge systems.
This is particularly important for rural communities, where 61% of sub-Saharan Africans live, according to the World Bank last year. These communities have often felt the brunt of urbanization, which has resulted in a shift away from rural economies. If implemented effectively, Africa could get a piece of the gastronomic tourism pie, which was worth $8.8 trillion last year, according to the World Travel & Tourism Council.
However, there is currently very little public information to pique the interest of tourists about African food. World-renowned South African chef Nompumelelo Mqwebu sought to remedy this with her self-published cookbook, Through the Eyes Of An African Chef.
“I think where it was very clear to me that I needed to do something was when I went to cooking school. I trained at Christina Martin School of Food and Wine. I thought I was actually going to get training on South African food and, somehow, I assumed we were talking indigenous food.
“I was shocked that we went through the whole year’s curriculum and we didn’t cover anything that I ate at home; we didn’t cover anything that my first cousins, who are Sotho, ate in Nelspruit (in South Africa’s Mpumalanga Province); we didn’t cover anything that would come from eSwatini, which is where my mother is from,” Mqwebu says.
By self-publishing, she has ultimately contributed to a value chain that has linked local food producers and suppliers, which includes agriculture, food production, country branding and cultural and creative industries.
“I am a member of Proudly South African, not only my business, but the book as well. Part of the reason is that the cookbook was 100% published in South Africa. So, everybody who worked on the cookbook, and printing, was all in South Africa, which is something quite rare these days because authors have their books published abroad.”
The Proudly South African campaign is a South African ‘buy local’ initiative that sells her cookbook on their online platform as its production adheres to the initiative’s campaign standards. Self-publishing has allowed Mqwebu to promote her book for two years and to directly communicate with her audience in a way she thought was best, while exposing her to a vast community of local networks. She recalls her first step towards creating her own body of work.
“I was in culinary school when I wrote the recipe for amadumbe (potato of the tropics) gnocchi. We were making gnocchi and I thought, ‘so why aren’t we using amadumbe because it’s a starch?’ and when I tasted it, I thought, ‘this could definitely work’. I started doing my recipes then.
“And there was talk about, ‘we don’t have desserts as Africans’. I did some research and found we ate berries, we were never big on sugar to begin with. That’s why I took the same isidudu (soft porridge made from ground corn) with pumpkin that my grandmother used to make and that became my dessert. “I also found that when I went to libraries looking for indigenous recipes, I couldn’t really find something that spoke to me as a chef. I found content that looked like history books. It was not appealing. It was not something, as a chef, I could proudly present to another chef from a different part of the world, so I knew I had to write my book,” Mqwebu says about the award-winning recipe book that chronicles African cuisine.
Financial and health benefits
According to the World Travel & Tourism Council, in 2018, the tourism sector “contributed 319 million jobs, representing one in 10 of all jobs globally and is responsible for one in five of all new jobs created in the world over the last five years. It has increased its share of leisure spending to 78.5%, meaning 21.5% of spending was on business.”
To narrow in on how lucrative food can be, the World Food Travel Association estimates that visitors spend approximately 25% of their travel budget on food and beverages. The figure can get as high as 35% in expensive destinations, and as low as 15% in more affordable destinations. “Confirmed food lovers also spend a bit more than the average of 25% spent by travelers in general.”
However, there is a widely-held view that the African continent is not doing enough to maximize its potential to also position itself as a gastronomic tourism destination, using its unique edge of indigenous knowledge systems (IKS).
“We are not a culinary destination and we will never be while we are still offering pasta as the attraction for our tourists,” Mqwebu says.
Dr George Sedupane, who is the Coordinator of the Bachelor of the Indigenous Knowledge Systems program in South Africa’s North-West University, echoes Mqwebu’s sentiments.
“I often cringe when I go to conferences and there are guests from all over the world and we serve them pasta. Why would they come from Brazil to eat pasta here? They can have pasta in Italy. Why don’t we serve them umngqusho (samp and beans)?
“We need to be creating those experiences around our culture. We are failing to capitalize on our strengths. There is a lack of drive to celebrate what we have,” says Sedupane, who also teaches modules and supervises research in indigenous health and nutrition.
Writer and historian Sibusiso Mnyanda says current innovations in African food technology are born out of necessity, rather tourism and cultural ambitions.
“Food security is becoming an issue that is leading to IKS around farming being prioritized. In Nigeria, they are innovating dry season farming, because of deforestation and soil being de-cultivated.
“So those indigenous knowledge strategies are being used in countries where it is a necessity and where there are enough advances related to the fourth industrial revolution. The traditional ways of producing food are not only much more organic, they are also crop-efficient,” Mnyanda says.
Nigeria may have inadvertently innovated a health solution related to colon cancer through its diet. Sedupane tells FORBES AFRICA an anecdote.
“There was a study where the colons of an African country that did not consume a lot of meat was compared to Europeans. The Africans had a much better profile as a result and there are people who want to buy African stool to get that kind of rich bacteria, that you get on an African plant-based diet.”
The study Sedupane is referring to was conducted in Nigeria and it states that: “Nigeria showed the average annual incidence of colorectal cancer was 27 patients per year. This shows that even if it seems that incidence rates are increasing in Nigeria, such rates are still about one-tenth of what is seen in the truly developed countries.”
In a bid to find reasons for this rarity of colon and rectal cancer, the study concluded that, among other reasons, the protective effects of Nigeria’s starch-based, vegetable-based, fruit-based, and spicy, peppery diet, and geographical location which ensures sunshine all year round, played a role in the country’s colon health.
Interestingly, it seems the potential value of African food could not only be based on what goes in but what also comes out as healthy faecal matter is big business globally. In 2015, The Washington Post published that one could potentially earn $13,000 a year selling their poop.
The American-based company OpenBiome has been processing and shipping frozen stool to patients who are very sick with infections of a bacteria called C.difficile. It causes diarrhea and inflammation of the colon, leaving some sufferers house-bound. “Antibiotics often help, but sometimes, the bacteria rears back as soon as treatment stops. By introducing healthy faecal matter into the gut of a patient (by way of endoscopy, nasal tubes, or swallowed capsules), doctors can abolish C. difficile for good… And yes, they pay for healthy poop: $40 a sample, with a $50 bonus if you come in five days a week. That’s $250 for a week of donations, or $13,000 a year,” the publication stated.
Sedupane is of the view that a diet which includes indigenous foods could vastly improve one’s quality of life.
He says small changes could be made, such as including more of indigenous greens, namely sorghum and millet, to breakfast. The grains are gluten-free and produce alkaline which boosts the pH level of fluids in the body and reduces acidity.
“Moving to our legumes, we have indlubu (Bambara groundnut) which is very rich and helps in the secretion of serotonin in the brain. This so important nowadays with the increase of depression. It’s easy to digest, and is great for cholesterol and moderating blood sugar,” Sedupane says.
Mnyanda is also of the view that food is imperative to health and medicinal properties. He says traditional healers primarily use natural herbs in their practice. “These are used in pain relief and healing. Things like cannabis, camphor, African potatao and red carrots. So, food is not just used for nutritional purposes.”
Other African superfoods include, Baobab fruit, Hibiscus, Tamarind, Kenkiliba, Amaranth, Moringa and pumpkin leaves.
Cultural and historical benefits
Gastronomic tourism also includes the promotion of heritage sites that are known to revolve around dishes that are of historic importance. They enhance the travel experience, they encourage the acquisition of knowledge and a cultural exchange.
There is a unanimous view that vast amounts of knowledge have been lost to history and there is a huge knowledge gap in African societies as a result of colonization and urbanization.
“Part of the colonial agenda was to make sure food security did not belong to indigenous groups. Therefore, archiving of these knowledge systems was not a priority. Especially during industrialization, where people moved from their villages to the city you found that the knowledge got left behind,” Mnyanda says.
He offers a contemporary example of how modernization continues to push African practices to the fringes: “To this day, abathwa (the San people) hunt their meat, but you find that because of changing agricultural practices and land reform on the Kruger National Park, they are being forced to move into the cities and industrial areas, therefore they are no longer able to practice their culture of hunting. As a result, their diet is changing.” Sedupane shares the view that the fundamentals of farming and astrology have also been exiled from public knowledge.
“The fundamentals of IKS were based on the understanding of the laws of nature – how and when things were done. Harvest cycles were linked with understanding astrology. They would not harvest until certain stars were visible in the sky. There was a dependence on nature.
“With industrialization, rather than working with nature, humans are seen as being above, as controlling, as directing it. The natural cycle is often tempered with rather than trying to work with it.”
Not all is lost however. There are historical practices that have stood the test of time and continue to be a part the few foods that are internationally associated with South Africa. Mqwebu says that, “historically, we ate more plants than meat because our ancestors had to hunt and the game back then was not tame. So, there were no guarantees that you would return with meat. And that’s where things like umqwayiba (biltong) come from. They had to preserve the meat, because wasting was not part of the culture”.
According to a 2015 exploratory research project conducted under the guidance of research institute Tourism Research in Economic Environs and Society director Professor Melville Saayman, biltong contributes more than R2.5 billion ($163 million) to the South African economy.
Perhaps, like the faecal transporting company, Africa will soon realize the ‘wasted’ opportunity and that there is loads of money to be made in gastronomic tourism for all its inhabitants, whether they are rural or urban, technological or indigenous.
Potential Cases Of Vaping-Related Illnesses Are Climbing
The number of potential vaping-related illness incidents under investigation by health federal authorities keeps climbing, as officials narrow their search on counterfeit vaping products, according to a report from the Washington Post.
- The Federal Drug Administration and the Centers for Disease Control said Friday they are investigating 215 potential cases of respiratory illness reported after use of e-cigarettes across 25 states. That’s up from 153 last week.
- Health officials say patients reported a gradual start to symptoms, such as breathing difficulty, shortness of breath and chest pain before hospitalization. Some cases reported vomiting, diarrhea, fevers or fatigue.
- According to the Washington Post, the investigation is focusing on counterfeit or black-market products that use potentially mislabeled solvents that consumers buy themselves.
- The announcement comes a week after the first vaping-related illness death was reported in Illinois.
Key Background: Although scientists are still unsure of vaping’s long-term health impact, most believe that e-cigarettes are a less dangerous nicotine source than tobacco cigarettes. The CDC recommends that all nonsmokers stay away from vaping.
The CDC warned users Friday of buying e-cigarette products off the street or adding any substances to products that are not intended by the manufacturer.
-Rachel Sandler; Forbes
Tasty Vegan Options: Consumed By Healthy Eating
The restaurant market still hungers for healthy options. This entrepreneur is feeding that need, serving earth-conscious customers and gym junkies.
Her desperation for a healthy meal fueled the fire for business.
Leigh Klapthor, 31, couldn’t find enough eateries that sold healthy food that was not bland, so decided to start her own.
“It is no fun to go out with friends and you are always the girl with the green salad,” she says.
“I wanted to find a way where being healthy is not such a chore and I also wanted for it to be affordable.”
Klapthor, who dropped out of a course in marketing communications at the University of Johannesburg, ditched a job in corporate marketing to pursue her passion for food.
In 2017, she started Sprout Café at the Stoneridge Centre in Edenvale in Johannesburg with a loan she received from her husband’s business and money that was given to them as a wedding gift.
“Everybody underestimates what everything will end up costing [when starting a new business]. In my mind, I thought R150,000 ($10,588) would work. I thought I would get my shop fitting and everything done and in the first month we would be able to pay salaries with the money we make,” says Klapthor.
But she soon realized the unforeseen challenges faced by many entrepreneurs. She had to eventually pump in a capital of R350,000 ($24,706) to start the venture.
“So I had a couple of life lessons at the beginning. I had to end up using our savings but I didn’t mind having to do that because I trusted and believed in the vision.”
But though she did, the banks did not because they often declined all her loan applications.
“I think there are so many young black and enthusiastic individuals that have brilliant ideas and vision but the investment capital is not there. Though I do not have the capital as well to assist them, I would say keep going because the vision is greater,” Klapthor says.
Sprout Café offers health food, light meals, vegan food, and vegetarian and ketogenic diet food.
With her corporate marketing skills, she advertised her food on social media and gained a lot of traction.
“I want to create food on Instagram and people are like, ‘oh my God, I want to eat that’ and when they come into the store, it is the same deliverable they receive,” she says.
Sprout Café turns over R3 million ($211,677) annually and has 10 employees.
After only two years of business, she has recently opened a second branch in the heart of the busy Moove Motion Fitness Club in Sunninghill in Johannesburg.
“There are people that are on specific diets and there is no one that is giving these people food. There is no one that is saying, vegan people want to be healthy too. They are making a conscious decision to preserve the environment and preserve their health and they are making these decisions but there is no one that is there to accommodate them.”
Klapthor says that the world is moving towards a plant-based lifestyle and she believes that many have recently caught on to that idea recently.
Trend translator Bronwyn Williams of Flux Trends, reiterates Klapthor’s views on how the world is adopting healthier habits. She believes that Generation Z is choosing good, clean fun the most.
“Yes, South Africa is not exempt from the global movement towards more locally-sourced and earth-friendly products and packaging,” Williams says.
However, Williams believes that because 64.2% of the South African population still lives in poverty, clean and organic food still remains costly for the majority of people.
“That said, unfortunately, earth-friendly consumer options remain a luxury that only the upper middle class can really afford to support and enjoy… certified organic, eco-friendly products tend to cost far more—up to 40% more than ‘regular’ packaged produce, it would be disingenuous to say that what the market wants is locally-sourced, earth-first produce when the majority of South Africans are struggling just to put any food on the table,” Williams says.
Though Klapthor knows more people are opening healthy-eating establishments because they see that it is a trend, she believes that they need to be in touch with the reality of an ordinary person’s life and consider the cost implications.
“You can’t charge someone R150 ($10.59) for a Beyond Meat burger and expect her to come back tomorrow for the same burger. People are tight with their money and they work hard for it, they do not want to let go, for instance, of R500 ($35.29) in three days,” Klapthor says.
“We want to provide a healthy lifestyle, something that is consistent and that people can live through, and not just a treat-themselves-to at the end of the month. Every day, you should be able to eat a Sprout meal without having to feel any kind of guilt and shame.”
Obviously, it is a concept that has worked and keeps her business healthy as well.
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