The northwestern Mexico state of Durango is on alert after an outbreak of aseptic meningitis. At least 12 people – 11 women and one man – have died during the past month in four private state hospitals due to a fungus present in four batches of bupivacaine, a local anesthetic. There have been more than 60 confirmed positive cases reported, the vast majority of them young women, according to the Durango State Health Secretariat (SSD). Despite the fact that the authorities have set up special areas in two public health centers to treat the infection, the situation has not yet stabilized and the number of cases is continuing to rise slowly.
“It will easily reach about 100 infections. The fungus is very aggressive in spite of treatment. Mortality can exceed up to 50% of cases. It is a tragedy; it will go down in the history of medicine”, says Eder Zamarrón, an intensive care specialist at the Hospital MAC Tampico. Experts concur the most probable hypothesis is the bupivacaine was contaminated by mishandling at health centers, although no one has so far assumed responsibility and no arrests have been made. “It would be speculating to attribute the cases to the bottles used or stored or applied as anesthetics to patients,” Mexico’s under-secretary for health, Hugo López-Gatell, said in a statement.
The illness is not contagious but there is no record of how many patients received the anesthetic and may have been exposed to the fungus. The health authorities are monitoring everybody who may have been given bupivacaine since March in any of the four affected hospitals – Parque, Santé, Dikcava and San Carlos, all located in the city of Durango and now temporarily closed – a number that could be in the hundreds. EL PAÍS has requested an interview with the SSD but at the time of this article going to print no response has been received. “The investigation to determine the causes of the meningitis will take time and will be focused on determining at what point in the process the contamination occurred,” López-Gatell Ramírez said in his statement, which added another 12 women are currently in serious condition.
The alarm in Durango over meningitis – a disease that inflames the tissues that cover the brain and spinal cord – was raised in early November. At that time, the origin of the disease was still unclear. Although it is normally transmitted by direct contact with an infected person, medical tests revealed that in Durango’s case the cause was a fungus – Fusarium solani – present in batches of bupivacaine and heavy bupivacaine. The drug is a local anesthetic used for short surgeries, its effects usually lasting around two hours. The contaminated batches were manufactured by Pisa, a pharmaceutical company based in Mexico, although the experts consulted agree that the fungus had been present in the drug since it was produced, stating it was most likely compromised in the four hospitals where the infections have been recorded, as Pisa supplies bupivacaine across Mexico and to some hospitals in other Latin American countries.
“To save resources they have reused the needles”
Consuelo Tinajero, an anesthesiologist at Silao General Hospital in Guanajuato, has been closely following the outbreak: “As anesthesiologists we were notified that cases of meningitis were occurring in the city of Durango and these were being associated with the use of bupivacaine. We were notified of the specific batches that were used and we were warned of the risk that existed if we gave an anesthesia. What strikes me is that Pisa distributes to the whole country but nowhere else have these types of cases been reported. At the hospital where I work, we perform a minimum of 12 to 15 neuraxial anesthesia procedures daily because we work with many pregnant patients and for a cesarean section, it is the ideal anesthesia.”
The vast majority of infected patients are young women who have given birth in the last few months and underwent caesarean sections. Alejandro Macias, one of the leading infection specialists in Mexico, says: “It is used less in men, for example, in hemorrhoid operations, which explains why basically women who have had cesarean sections are affected. We can practically rule out the possibility that the medication is contaminated, unless it was contaminated at the site of use. One of the most probable hypotheses is that, in order to save resources, the needles were reused.”
The needles, Macias explains, are disposable and inserted into the syringe through plastic, which cannot be disinfected at high temperatures because the material melts. “There’s a thing called cold sterilization, but it’s based on the false idea that you can sterilize something without using an autoclave [a high-temperature sterilizing machine]. They often use disinfectants and then cold disinfection systems thinking that it’s going to leave the needle sterile but it’s not true; those systems don’t sterilize the inside of the needle. If it was contaminated and the fungus was present inside it, they would have injected the analgesic into the central nervous system.”
Tinajero agrees, explaining that in the type of anesthesia for which bupivacaine is used, the drug is introduced directly into the central nervous system using a “very thin” needle. “I suspect the syringes: they used to be made of glass, they were not discarded but re-sterilized, sometimes with heat or with other substances, including alcohol. I think these hospitals are still using this type of reusable glass syringe.”
The experts consulted also reject the idea that, despite most of the affected patients being women, what has happened in Durango is a case of obstetric violence – “violence exercised by health professionals towards pregnant women during childbirth and the postpartum period”, as defined by the World Health Organization. “I would not label it as obstetric violence. I think the doctors who administered the anesthesia acted correctly and did not know the risk they were subjecting the patients to,” says Tinajero.
“The responsibility lies with the hospital managers”
“Another hypothesis,” Macias points out, “is that they may have bought the medicine on the black market, where they sometimes prepare the drugs in a garage. If they bought it there to save resources, labels may have been falsified or complete batches contaminated.” Does that constitute medical negligence? “Absolutely, yes. It’s a problem that happens a lot in developing countries to save resources. If that is the case, this is one of the worst instances of failures in the most basic measures of care I have ever seen.”
Tinajero, however, stresses: “I would not call it medical negligence because we as physicians and anesthesiologists have no way of knowing if the medication is contaminated or if the needles have been sterilized, although we can tell if they give us reusable syringes, if they are made of glass and not plastic. The responsibility lies with the hospital directors; they know that they are not sterilizing properly, or are re-sterilizing single-use material, or if they bought apocryphal medication. The hospital’s supplier should be aware of that, and they should be investigated.”
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Uganda condemned for ‘shameful’ decision to close UN human rights office | Global development
Rights activists and campaigners have condemned the Ugandan government’s decision to shut down the country’s UN human rights office, describing it as “shameful”.
In a letter to the Office of the UN high commissioner for human rights (OHCHR) in Uganda dated 3 February, the foreign affairs ministry said it will not renew the host country agreement it signed with the OHCHR, which established its initial mandate in the country in 2005. The current mandate, signed on 9 February 2020, expires in August.
“The government of Uganda will now continue its cooperation with the OHCHR Headquarters either directly or through its Permanent Mission in Geneva,” reads the letter.
The development comes less than three months after the UN’s committee against torture adopted the concluding observations on Uganda, which raised concerns that torture and ill-treatment continued to be frequently practised, and called for investigation and prosecution of security officials accused of excessive use of force, violence and arbitrary detention.
“The closure of the @UNHumanRightsUG office proves that [the] government has lost all sense of shame. It no longer wants any close international scrutiny of its human rights record,” tweeted Adrian Jjuuko, executive director of the Human Rights Awareness and Promotion Forum.
“If the protectors are sent away, what then happens to those they were protecting? We are headed for tough times,” he added.
Bobi Wine, the reggae singer turned Ugandan opposition leader, whose supporters remain in unauthorised places of detention or “safe houses”, said it was no surprise that Uganda’s president, Yoweri Museveni, who has been in power since 1986, has closed the OHCHR. He tweeted: “In the face of growing international condemnation and isolation, tyrant Museveni has responded by shutting down NGOs, Facebook, DGF [Democratic Governance Facility] & declaring several internationals Persona Non-Grata or deporting them! Now he shuts down @UNHumanRightsUG.”
Wine added: “You’ll recall in the aftermath of the 2021 election and the hundreds killed or abducted by the Museveni regime, we petitioned the UN Human Rights Office & the military brutalised journalists right there. This UN Office condemned these actions. Not surprising it’s being closed.”
Human right activists and advocacy groups have called the decision a “mockery” and accused the government of running from international scrutiny on abuse and protection of human rights.
“This is unbelievable, and the reasons given by the government are a mockery of the real state of human rights in the country,” said Jjuuko. “To claim that Uganda no longer needs the office [OHCHR] because of its strong stand for human rights is ironic to say the least.
“A strong stand for human rights would imply opening up to the UN and other actors.”
David Livingstone Sewanyana, founder of the Foundation for Human Rights Initiative in the capital, Kampala, told the Guardian, “The decision not to renew the mandate deprives Uganda of a critical player in the field of human rights promotion and protection.”
At least 38 local and international staff at the head office in Kampala and two field offices in Gulu and Moroto stand to lose their jobs.
Jjuuko said: “Following closely on the closure of the DGF, this is a scary move which indicates that the government is no longer willing to have its human rights record scrutinised by international actors.
“This leaves local organisations at much more risk of being further silenced and their work curtailed without the government fearing close international security. It is a sad day indeed for the human rights movement in Uganda.”
2023 State of the Union address, live | Biden will call for collaboration with Republicans | USA
On the List: Biden’s guests at the State of the Union address
In the highly theatrical ritual of the State of the Union address, delivered each year by the President of the United States to a joint audience of congressmen and senators on Capitol Hill, the most eagerly awaited list in the hours leading up to the address is that of those invited by the President himself to attend his speech on the floor of the House of Representatives. They are carefully chosen to underscore with their presence the points the president wants to emphasize. This year they range from rock stars (Bono) to anonymous citizens unwittingly placed at the center of a whirlwind of tragedy and media attention, such as the parents of Memphis teen Tyre Nichols, the latest name to enter the history of police brutality infamy in the country.
What follows is a list of some of those illustrious guests at tonight’s speech in Washington:
Bono. Singer of the Irish band U2 and activist for the most varied causes, for whose fight he deploys his worldwide fame.
Oksana Markarova, the Ukrainian ambassador to the United States. She was already invited last year, when Biden’s first speech came six days after the Russian invasion of Ukraine. Nearly a year later, the end of the war seems far off, but the U.S. commitment to Kiev’s cause remains unwavering.
Row Vaughn and Rodney Wells, mother and stepfather of Tyre Nichols. Five police officers beat him to death last month in Memphis. His case, and the poise of his parents, have reopened the debate about police brutality in the United States, an issue that seemed on the mend after the chokehold death of African-American George Floyd at the hands of a white Minneapolis police officer on May 25, 2020.
Brandon Tsay, another anonymous man at the center of American political power. Tsay disarmed the killer of 11 people in one of the latest mass shootings to horrify the country. It happened in Monterey Park, California, and the tragedy ripped the Asian American community in half.
Deanna Branch. Lead was found in her son’s blood because of water coming out of the home’s plumbing. The Biden Administration has set a goal of replacing all lead pipes in the country within the next decade.
Mitzi Colin Lopez. Immigrant rights activist, specializing in advocacy for dreamers.
Doug Griffin of Newton, New Hampshire. Lost a daughter to a fentanyl overdose. Biden plans to stress the importance of the fight against opioids. The drugs have taken the lives of 100,000 Americans by 2022.
Amanda Zurawski, Texas neighbor. She almost died because of restrictive anti-abortion laws that came out of the Supreme Court ruling that eliminated a woman’s federal right to choose.
High-profile lawsuit against Meta can be heard in Kenya, Nairobi court rules | Global development
A Kenyan court has ruled that a case brought against Facebook by a former content moderator can go ahead.
Daniel Motaung, who was hired as a Facebook content moderator by the tech firm’s subcontractor Sama in 2019, filed a suit against the two companies last year, alleging that he had been exposed to graphic and traumatic content at work, without adequate prior knowledge or proper psychosocial support – which he says left him with post-traumatic stress disorder.
He also claimed he was unfairly dismissed after trying to unionise his co-workers to fight for better conditions.
Facebook’s parent company, Meta, contested its involvement in the case, saying that Sama was Motaung’s employer, and Meta could not be subjected to a hearing in Kenyan courts because it was not registered, and did not operate, in the country.
However, on Monday the judge found that the tech giant was a “proper party” to the case.
The Kenya employment and labour relations court is yet to release its full ruling on Motaung’s case, but the decision – the first of its kind in Africa – is already being hailed as a win for the accountability of big tech on the continent, and in the global south.
“If the attempt by [Meta] to avoid Kenyan justice had succeeded, it would have undermined the fundamental tenets of access to justice and equality under the law in favour of foreign privilege,” said Irũngũ Houghton, executive director of Amnesty International Kenya.
“We finally have an avenue for accountability,” said Odanga Madung, senior researcher for platform integrity at Mozilla. “It calls for tech giants to make serious changes within their companies that take into consideration their workers and users outside the US and Europe.”
Cori Crider, director of Foxglove, a UK tech justice non-profit, which supported the Motaung case, said social media platforms should not outsource critical online safety functions like content moderation. “It is the core function of the business. Without the work of these moderators, social media is unusable. When they are not able to do their jobs safely or well, social media’s safety brutally falters.”
Meta is facing a second court case in Kenya, which was due to be heard this week but has been postponed. It was filed by two Ethiopian petitioners and a Kenyan rights advocacy group, Katiba Institute, who claim that the company failed to take online safety measures to manage hate speech on the platform during northern Ethiopia’s civil war – which they say fanned the conflict, with serious offline consequences.
The father of one of the petitioners was killed after a violent Facebook post that was reported, but not acted on in time. The petitioners claim that Facebook also failed to recruit enough moderation staff to its regional hub in Nairobi.
“There are problems with Facebook’s woeful failure to value or to staff content moderation outside of the English-speaking United States,” said Crider, adding that Monday’s ruling could have global and regional implications on how tech firms think about and manage content moderation.
Leah Kimathi, a convenor for the Council for Responsible Social Media, agrees. “Big tech should not just look at Kenyans as a market, but should be accountable and alive to the nuances, needs and peculiarities of Kenya, especially when it comes to content moderation.”
A nationwide poll conducted in 2022 by the Council for Responsible Social Media showed that 68% of Kenyans who have internet access get their news from social media, and that a majority of these feel that social media platforms could do more to remove harmful content.
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