Forging a sustainable response to HIV/AIDS in the Caribbean--the strategic role of a regional conference.

The paper provides a rationale for a Caribbean HIV/AIDS Conference as a key ingredient to the regional response mechanism. This initiative stems from the need to address crucial elements of the regional response within the realities of the present regional economic situation and global financial climate, as well as epidemiological and demographic trends. A mixed method approach was adopted for this study, drawing on both primary and secondary data collection techniques. A small survey of leaders and senior practitioners formed the basis of the primary data collection phase, complemented by key informant interviews. The paper proposes a model for a Caribbean HIV Conference that can better position the regional response in line with the present global and local socio-economic and health landscape. Central to this model is the repositioning of the Conference from an "Event" to being an "Activity" in the regional planning agenda and the positioning of the Conference as a fundamental fixture of the region's health calendar. The positive externalities from the synergies developed around the Conference can be identified in terms of the quantifiable costs savings to Agencies. The less quantifiable path relates to networking, exchanges and stronger regional ties that are facilitated through the activity. The main findings of the survey of health leaders indicate significant support for an ongoing regional conference. The results therefore endorse the location of a Conference entity together with the relevant support mechanisms as a key feature on the Caribbean's health landscape.

Health priorities in developing countries.

In essence then, the health sector in developing countries is weak and fragile; it is vulnerable to external financial pressures and the vagaries of national budget priorities. Throughout the world, leaders in health must seek more effective ways of impressing upon others who make national policy the long term consequences of crises which disrupt health services. Above all, the impact of disinvestment in health in creating underdevelopment and the value of investment in health in creating development must be demonstrably established. Health must be seen as an engine of national development.

Inspiratory valve malfunction in a circle system: pitfalls in capnography

Capnography is a useful technique in monitoring the integrity of anaesthetic equipment such as the malfunctioning of unidirectional valves in circle system. However, the lack of a precise mechanism in existing capnographs to identify the start of inspiration and the beginning of expiration in the capnograms, makes the analysis of the carbon dioxide waveforms during inspiration difficult and thus results in inaccurate assessement of rebreathing. We report a case where, during the malfunction of the inspiratory unidirectional valve in the circle system, the capnograph failed to detect the presence of substantial rebreathing. Critical analysis of the capnogram recorded during the malfunction revealed that there was substantial rebreathing which was underestimated by the capnograph as it reports only the lowest CO2 concentration rebreathed during inspiration in such abnormal situations.(AU)

AIDS - the legal and ethical issues confronting the medical profession - abstract

The AIDs pandemic has brought in its wake a number of legal and ethical dilemmas for the members of the medical profession. The extent of the duty of the doctor care for the HIV-infected patient; how much exposure the health professional should be willing to risk; and whether the criteria for research and experimentation, terminal care and access to life-sustaining treatment should be modified for HIV-infected persons are some of the very vexed issues being currently debated. Problems of confidentiality; consent; reporting and notification of HIV status; disclosure to third parties at risk; discrimination; isolation and detention; irresponsible, violent or dangerous patients; mental competence; living wills and power of attorney all complicate the management of the HIV-infected. The HIV-infected doctor presents a particularly difficult quandary. While most people will readily accept the exposure of the doctor to the illnesses of patients, and the possibility of contagion comes with the territory, few seem to accept that the reverse is true. The World Health Organization estimates that by the year 2000, about 10 million infants and children will have been infected by the HIV and that an even greater number will be uninfected but orphaned as a result of the AIDS pandemic. In addition to the tremendous social and public health consequences, there are difficult legal and ethical problems to be grappled with in managing these children (AU)