MERO INTERNATIONAL - MI DOCTORS ACROSS BORDERS GLOBAL MEDICAL ASSISTANCE

How Can We Prevent Infection Of Newborns? Mothers can reduce the risk of infecting their babies if they: Use antiretroviral medications (ARVs), Keep the delivery time short, and Take precautions with breast feeding Use antiretroviral medications (ARVs): The risk of transmitting HIV is extremely low if ARVs are used. Transmission rates are only 1% - 2% if the mother takes combination antiretroviral therapy (ART). The rate is about 4% when the mother takes AZT (also known as ZDV or Retroviral) during the last six months of her pregnancy, and the newborn takes AZT for six weeks after birth. Contact with Blood HIV is one of many diseases that can be transmitted by blood. Be careful if you are helping someone who is bleeding. If your work exposes you to blood, be sure to protect any cuts or open sores on your skin, as well as your eyes and mouth. Your employer should provide gloves, facemasks and other protective equipment, plus training about how to avoid diseases that are spread by blood. If You Have Been Exposed If you think you have been exposed to HIV, talk to your health care specialist and/or the public health department, and get tested. If you are sure that you have been exposed, call your doctor immediately to discuss whether you should start taking antiretroviral drugs (ARVs). This is called \"post exposure prophylaxis\" or PEP. You would take two or three medications for several weeks. These drugs can decrease the risk of infection, but they may have some serious side effects. Can I Take PEP If I Am Pregnant? Yes. If you are pregnant, you can still take PEP. Your medical specialist will discuss the benefits and risks to you and your baby; and you should stop breastfeeding for 3 months after the exposure whiles breastfeeding. 51

Post-Exposure Prophylaxis Prophylaxis means disease prevention. Post-exposure prophylaxis (or PEP) means taking antiretroviral medications (ARVs) as soon as possible after exposure to HIV, so that the exposure will not result in HIV infection. These medications are only available with a prescription. PEP should begin within as soon as possible after exposure to HIV but certainly within 72 hours. Treatment with 2 or 3 ARVs should continue for 4 weeks, if tolerated. Who Should Use PEP? Workplace Exposure PEP has been standard procedure since 1996 for healthcare workers exposed to HIV. Workers start taking medications within a few hours of exposure. Usually the exposure is from a \"needle stick,\" when a health care worker accidentally gets jabbed with a needle containing HIV-infected blood. PEP reduced the rate of HIV infection from workplace exposures by 79%. However, some health care workers who take PEP still get HIV infection. Other Exposure In 2005, the Centres for Disease Control reviewed information on PEP. They concluded that it should also be available for use after HIV exposures that are not work-related. People can be exposed to HIV during unsafe sexual activity, when a condom breaks during sex, or if they share needles for injecting drugs. Infants can be exposed if they drink breast milk from an infected woman. In a study of PEP in 400 cases of possible sexual exposure to HIV, not one person became infected with HIV. Should PEP Be Used For Non-Occupation Exposure? HIV exposure at work is usually a one-time accident. Other HIV exposures may be due to unsafe behaviours that can occur many times. Some people think that PEP might encourage these unsafe behaviours if people think that PEP is an easy way to avoid HIV infection. There are other reasons why PEP might not be a good idea for non- occupational exposure: There is no research to show that PEP works for non-occupational exposure. We don't know how soon after exposure to HIV someone has to start PEP. PEP is not a \"morning-after pill.\" It is a programme of several drugs, several times each day, for at least 30 days. PEP costs between US$600 and US$1,000. 52

For best results, you have to take every dose of every PEP medication. Missing doses could mean that you develop HIV infection. It could also allow the virus to develop resistance to the medications. If that happens they would no longer work for you. The medications have serious side effects. About 40% of health care workers did not complete PEP because of the side effects. Despite these concerns, there is growing interest in PEP for non- occupational exposure. Most programmes include health counselling to inform and encourage people to avoid exposure to HIV. How Is PEP Taken? PEP should be started as soon as possible after exposure to HIV. The medications used in PEP depend on the exposure to HIV. The following situations are considered serious exposure: Exposure to a large amount of blood Blood came in contact with cuts or open sores on the skin. Blood was visible on a needle that stuck someone. Exposure to blood from someone who has a high viral load (a large amount of virus in the blood). For serious exposures, Public Health Service recommends using a combination of three approved ARVs for four weeks. For less serious exposure, the guidelines recommend four weeks of treatment with two drugs: AZT and 3TC. In January 2001, the Centres for Disease Control warned against using Nevirapine for PEP because of the risk of liver damage. What Are The Side Effects? The most common side effects from PEP medications are nausea and generally not feeling well. Other possible side effects include headaches, fatigue, vomiting and diarrhoea. Post-exposure prophylaxis (PEP) is the use of ARVs as soon as possible after exposure to HIV, to prevent HIV infection. PEP can reduce the rate of infection in health care workers exposed to HIV by 79%. The benefits of PEP for non-occupational exposure have not been proven. This use of PEP is controversial because some people fear it will encourage unsafe behaviours. 53

PEP is a four-week program of two or three ARVs, several times a day. The medications have serious side effects that can make it difficult to finish the programme. PEP is not 100% effective; it cannot guarantee that exposure to HIV will not become a case of HIV infection. HIV is a type of virus called a retrovirus. Like all viruses, it must invade the cells of other organisms to survive and reproduce. HIV multiplies in the human immune system's CD4+ T cells and kills vast numbers of the cells it infects. The result is disease symptoms. There Are Two Forms of HIV HIV-1 is the more common and more potent form. This form of HIV has spread throughout the world. HIV-2, which is less potent that HIV-1, is found predominantly in West Africa. It is also more closely related to two HIV-like viruses found in monkeys. There also are different strains of the virus, which makes it difficult to find one single treatment The Immune System Our bodies use a natural defence system to protect us from bacteria, fungi, viruses, and other microscopic invaders. This system includes general, non- specific defences as well as weapons custom-designed against specific health threats: Innate, or non-specific, immunity is the first line of defence. Our skin, tears, mucus, and saliva, as well as the swelling that occurs after an infection or injury, contain types of immune cells and chemicals that attack disease- causing agents attempting to invade the body. Adaptive, or specific, immunity uses specialized cells and proteins called antibodies to attack invaders that get past the first line of defence. These weapons target specific proteins called antigens, found on the surface of the invading organism. The immune system can quickly rally these custom- tailored defences if this particular invader attacks again. There Are Two Types Of Adaptive Immune Responses The hum-oral immune response involves the action of specialized antibody- producing white blood cells. The antibodies (proteins produced by the immune system to fight infectious agents such as viruses), which circulate in the blood and other body fluids. 54

This can recognize specific antigens (substances that stimulate the production of antibodies). They latch onto the viruses, bacteria, toxins, and other substances that bear these antigens, targeting them for destruction. Hairy Leukoplakia on the lateral border of the tongue in a 28 year old patient Lesions of smaller size were also found on the mouth and the lips shown of the same patient. The cell-mediated immune response involves the action of another group of specialized white blood cells that direct and regulate the body's immune responses or directly attack cells that are infected or cancerous. How Do White Blood Cells Help Fight Disease? White blood cells, particularly macrophages and B and T lymphocytes, play central roles in the immune system's defences against viruses and other foreign invaders. Macrophages contribute to both non-specific and specific immune responses. These versatile cells act as scavengers, engulfing and digesting microbes and other foreign material in a cell-eating process called phagocytosis. They also, upon encountering an invading organism, release chemical messengers that alert other cells of the immune system and summon T lymphocytes to the infected area. B lymphocytes, or B cells, serve as the body's antibody factories. Each antibody is targeted to recognize and bind to an antigen from a specific invader. When antibodies circulating through blood and body fluids encounter this invader, they mark it for destruction. T lymphocytes, or T cells, are part of the cellular immune response. Some T cells, like CD4+ T cells (also called \"helper\" T cells), direct and regulate the body's immune responses. Others are killer cells that attack cells that are infected or cancerous. 55

How Does HIV Infection Become Established In The Body? Researchers have found evidence that immune-system cells called dendritic cells may begin the process of infection. After exposure, these special cells may bind to and carry the virus from the site of infection to the lymph nodes, where other immune system cells become infected. HIV targets cells in the immune system that display a protein called CD4 on their surface. These cells are called CD4-positive (CD4+) cells. When HIV encounters a CD4+ cell, a protein called gp120 that protrudes from HIV's surface recognizes the CD4 protein and binds tightly to it. Another viral protein, p24, forms a casing that surrounds HIV's genetic material. HIV's genetic material contains the information needed by the virus to infect cells, produce new copies of virus, or cause disease. For example, these genes encode enzymes that HIV requires to reproduce itself. Those enzymes are reverse transcriptase, integrase, and protease Safe Sex Sexually transmitted diseases (STDs) are spread by sexual contact involving the genitals, mouth, or rectum, and can also be spread from a pregnant woman to her foetus before or during delivery. STDs, which affect both men and women, are a worldwide public health concern. While most STDs can be cured, some cannot, including HIV (which causes AIDS), genital herpes, and human papillomavirus (HPV), which can cause genital warts. One of Oxfam's principal activities in the fight against the spread of HIV/AIDS is to educate people about methods of safe sex, including demonstrations in the use of condoms. We also emphasise that government must define a clear distinction between excellent public health programmes and social awareness to that of the complexities, difficulties and social nightmare we all face. Government must take leadership and responsible for their entire nation, provide the mechanism for excellent healthcare, education, job, budget, support and the facilitation in terms of access to people and resources. 56

STDs can be spread by people who don't know they are infected. Always use protection every time you have sex, until you are sure you and your partner are not infected with a STD. If you are in a relationship, delay having sex until you are physically and emotionally prepared, have agreed to only have sex with each other, and have both been tested for STDs. Abstinence As Prevention Completely avoiding sexual contact (abstinence), including intercourse or oral sex, is certain the most common way to prevent an infection. Discuss safe sex with your partner Discuss STDs before you have sex with someone. Even though a sexual partner doesn't have symptoms of an STD, he or she may still be infected. Questions To Ask Before Having Sex How many people have you had sex with? Have you had sex without a condom? Have you ever had anal sex? Have you ever had unprotected oral sex? Do you have many sex partners? Do you inject illegal drugs or have you had sex with someone who injects drugs? Have you ever had unprotected sex with a prostitute? Have you ever had an STD, including hepatitis B or hepatitis C? Was it treated and cured? These questions are very personal and difficult, however it‘s always to the best interest to remove all doubts and build personal confidence before one commence a relationship. The bottom line is to get to know your partner first, before it‘s too late. Safe Sex Practices Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood. Genital herpes and the human papillomavirus (HPV) can be spread when symptoms are not present. Even if you and your partner have been tested, use condoms for all sex until you and your partner haven't had sex with another person for 6 months. Then get tested again. Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating. 57

Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of their partners may have. Your risk for an STD increases if you have several sex partners at the same time. Use a condom every time you have sex. Latex and polyurethane condoms do not let STD viruses pass through, so they offer good protection from STDs. Condoms made from sheep intestines do not protect against STDs. Use a water-based lubricant such as K-Y Jelly or Astroglide to help prevent tearing of the skin if there is a lack of lubrication during sexual intercourse. Small tears in the vagina during vaginal sex or in the rectum during anal sex allow STDs to get into your blood. Women should avoid douching, because it can change the normal balance of organisms in the vagina and increases the risk of getting an STD. Be responsible. Avoid sexual contact if you have symptoms of an infection or if you are being treated for a STD or HIV. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times. How Is HIV Infection Spread? There are many misunderstandings about the ways in which HIV infection is not spread. However, the most common way is through sexual intercourse; HIV is spread most commonly by sexual contact with an infected partner. The virus can enter the body through the lining of the vagina, penis, rectum, or mouth during sexual relations. Sexual Activities That Can Result In HIV Infection Sexual intercourse Anal sex (heterosexual or homosexual) Oral sex (heterosexual or homosexual) Can HIV Be Spread Through Kissing? Although studies have found tiny amounts of HIV in the saliva of some people with HIV, researchers have found no evidence that HIV is spread to other people through kissing. However, the CDC recommends against \"French\" or open-mouthed kissing because of the possibility of contact with blood if the people kissing have any cuts or sores in the mouth 58

Direct Contact with Infected Blood HIV can be spread through direct contact with infected blood: Through injected drugs. HIV frequently is spread among users of illegal drugs that are injected. This happens when needles or syringes contaminated with minute quantities of blood of someone infected with the virus are shared. In a health-care setting. Transmission from patient to health-care worker or vice-versa - via accidental sticks with contaminated needles or other medical instruments - can occur, but this is rare. Through a blood transfusion. Prior to the screening of blood for evidence of HIV infection and before the introduction in 1985 of heat-treating techniques to destroy HIV in blood products, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of acquiring HIV from such transfusions is extremely small; however there are many cases where patients were infected due to professional negligence in the work place. An Infected Mother to Her Unborn Child Women can transmit HIV to their foetuses during pregnancy or birth. Approximately one-quarter to one-third of all untreated pregnant women infected with HIV will pass the infection to their babies. A pregnant woman can greatly reduce the risk of infecting her baby if she takes the anti-HIV drug AZT (also called Zidovudine) during her pregnancy. Because the risk of transmission increases with longer delivery times, the risk can be further reduced by delivering the baby by caesarean section, a surgical procedure in which the baby is delivered through an incision in the mother's abdominal wall and uterus. Combining AZT treatment with caesarean delivery can reduce the infection rate to between 1% and 2%. HIV also can be spread to babies through the breast milk of mothers infected with the virus. Women who live in countries where safe alternatives to breast-feeding are readily available and affordable can eliminate the risk of transmitting the virus through breast milk by bottle-feeding their babies. In developing countries, however, where such safe alternatives are not readily available or economically feasible, breast-feeding may offer benefits that outweigh the risk of HIV transmission. 59

How Is HIV Infection Not Spread? Research indicates that HIV is NOT transmitted by casual contact such as: Touching or hugging Sharing household items such as utensils, towels, and bedding Contact with sweat or tears Sharing facilities such as swimming pools, saunas, hot tubs, or toilets with HIV-infected people. Coughs or Sneezes In short, studies indicate that HIV transmission requires intimate contact with infected blood or body fluids (vaginal secretions, semen, pre-ejaculation fluid, and breast milk). Activities that don't involve the possibility of such contact are regarded as posing no risk of infection. Sexually transmitted diseases (STDs) Sexually transmitted diseases (STDs)—also referred to as sexually transmitted infections (STIs)—are those spread by sexual contact. They may also be spread from a pregnant woman to her foetus before or during delivery. Exposure to an STD can occur anytime a person has sex or close contact that involves the genitals, the mouth, or the rectum with another person, but exposure is more likely if a person has many sex partners or does not use condoms. STDs can be prevented by not having sexual contact (abstinence). Is It Safe To Share A Household With An HIV-Infected Person? Studies of families of HIV-infected people have found that HIV is not spread through sharing utensils, towels, bedding, or toilet facilities. Behaviours that increase the likelihood of contact with blood from an HIV-infected person, such as sharing a razor or toothbrush, should be avoided. 60

STDs Include: Chlamydia Genital Herpes Genital warts or human papillomavirus (HPV). Certain types of HPV can cause cancer of the cervix in women. Gonorrhoea Hepatitis B Syphilis Trichomoniasis Human immunodeficiency virus (HIV), which causes AIDS Other infections that may be sexually transmitted, including Hepatitis C, Cytomegalovirus, Scabies, and Pubic Lice. Most STDs can be treated and cured, but some cannot. Some STDs, such as HIV and Syphilis, can cause death. Human Papillomavirus - HPV The human papillomavirus (HPV) causes warts, including genital warts, and may cause cancerous changes in the cervix. HPV is spread by direct contact. There are more than 100 known types of HPV. Some HPV types cause genital warts. In women, certain types of HPV increase the risk of cervical cancer. Sometimes the only sign that a woman is infected with HPV is an abnormal Pap test result. Other types of HPV cause common, plantar, filiform or flat warts, and some genital warts. These types of warts are not cancerous. There is no known cure for HPV. Most warts go away without treatment within 2 years; however medications and treatments are available to help warts disappear more quickly. HPV remains in the body with or without treatment for visible warts, so warts may come back. Symptoms of a sexually transmitted disease (STD) Sexually transmitted diseases (STDs) may cause many different symptoms in both women and men. 61

In Women A thick, discoloured, or foul-smelling vaginal discharge. Symptoms may get worse over a period of several days to 2 weeks. Pain, burning, or itching while urinating for longer than 24 hours Fever Pain during sexual intercourse Pain or a feeling of heaviness in the pelvis or lower abdomen Itching, tingling, burning, or pain in the genitals Sores, lumps, blisters, rashes, or warts on or around the genitals Vaginal spotting or bleeding after sexual intercourse Other symptoms of an infection, such as fever and fatigue or lack of energy In men Painful Urination - This is often the first symptom. Fever Cloudy Urine Abnormal discharge from the penis Crusting at the tip of the penis Sores, lumps, blisters, rashes, or warts on or around the genitals Pain, swelling, or tenderness in the scrotum (epididymitis) Itching, tingling, pain, or burning of the genitals Deep Pelvic Ache (prostatitis) These symptoms require medical attention. Avoid any sexual contact until you have been examined by a medical professional and the result turned out negative. New HIV Treatment Is Combination 1-A-Day Drug Approval of a new combination tablet to treat HIV will make it easier for people to follow their treatment regimen. 62

The Food and Drug Administration (FDA) USA, has approved a once-a-day, three-drugs-in-one, fixed-dose combination called Atripla. The new pill combines the active ingredients of three anti-retroviral drugs already in use to treat HIV/AIDS — Efavirenz (Sustiva), Emtricitabine (Emtriva) and Tenofovir Disoproxil Fumarate (Viread). These drugs have already been used together for some time as part of a \"cocktail\" therapy. According to the FDA, Atripla will contain a package warning that the drug may cause build-up of lactic acid in the blood. Other potential serious side effects may include serious liver toxicity, kidney impairment and severe depression. In a 48-week trial, the most common side effects experienced by participants were headache, dizziness, abdominal pain, nausea, vomiting and rash. If you're being treated for HIV/AIDS, you now have a simple course of treatment to follow. Chest x-ray film of a 41-year-old woman with HIV infection shows enlarged cardiac silhouette. The woman was admitted with Dyspnea and Pleuritic chest pain. Nine years earlier, she was found to be HIV-seropositive secondary to injection drug use. The patient had had 2 episodes of Pneumocystis Carinii Pneumonia in the past and was receiving combination antiretroviral therapy with Indinavir, Zalcitabine, and Nelfinavir as well as Prophylaxis; which was administrated to assist her against further opportunistic infections. This patient had been noncompliant with her medications for several weeks before presentation. Her CD4 cell count was 400/µL and the viral load was 750,000 copies/ml at the time of admission. Her physical examination was significant for distant heart sounds and a pericardial rub. A chest roentgenogram revealed an enlarged cardiac silhouette, which was confirmed by echocardiography to be a large pericardial effusion with collapse of the right atrium during late diastole. The ECG revealed electrical alternans, and a cardiac pretamponade picture developed. A subxiphoid pericardiotomy was performed, with drainage of 500 ml of serosanguineous fluid. An analysis of the pericardial fluid was nondiagnostic by stains (Gram and acid-fast stains), cultures (bacterial, fungal, mycobacterial, and viral), cytology, and chemistry. A pericardial tissue biopsy revealed fibrosis with chronic inflammatory changes. 63

The patient improved clinically after the procedure, and the pericardiotomy tube was removed on the 4th day. She is now compliant with her medications and has remained asymptomatic for the past 2 years. The newly approved tablet combines three medications that have been in use for several years, and whose results and effects are well-known. Many people with HIV/AIDS take additional drugs beyond the three that have been combined into the new tablet, in order to deal with complications and AIDS-related infections. The new combination pill won't eliminate the need for these people to continue to take other medications. However, the ability of more people to easily follow a course of treatment for HIV/AIDS holds the prospect of bringing the AIDS epidemic under control. Emtriva Important Information You Should Know About Emtricitabine Emtricitabine may cause lactic acidosis or severe liver damage, which can be fatal. Call your doctor at once if you have any of these symptoms, which may be early signs of lactic acidosis or liver problems: nausea, vomiting, or sudden stomach pain; weak or tired feeling; dizziness or lightheadedness; fast or irregular heartbeats; feeling short of breath; cold feeling, especially in the arms and legs; jaundice (yellowing of the skin or eyes); or pain in the upper stomach area. Pope John Paul said ―The Roman Catholic Church and its Health have to pay particular attention to helping AIDS sufferers in the developing world‖. We are seeing people of all walks of life worldwide, reaching out to HIV/AIDS victims. We as people, nation and government must work together to curtail this epidemic by combining our resources, interchanging ideas, workshops, technologies; and the richer people and nations must give their economic support. The world future is dime, we have 38 million children with AIDS; what will be the figures in the next five years. The world future is dime, we have 38 million children with AIDS; wha6t 4will be the figures in the next five years.

Treatment of HIV/AIDS almost always requires using many medicines together. To best treat your condition, use all of your medications as directed by your doctor. Do not change your doses of medication schedule without advice from your doctor. Every person with HIV or AIDS should remain under the care of a doctor. Taking this medication will not keep you from passing HIV to other people through unprotected sex or sharing of needles. Talk with your doctor about safe methods of preventing HIV transmission during sex, such as using a condom and spermicide. Sharing drug or medicine needles is never safe, even for a healthy person. What Is Emtricitabine? Emtricitabine is an antiviral medication. It is in a category of HIV medicines called reverse transcriptase inhibitors. Emtricitabine works by preventing HIV cells from multiplying in the body. Emtricitabine is used to treat the human immunodeficiency virus (HIV), which causes the acquired immunodeficiency syndrome (AIDS). Emtricitabine is not a cure for HIV or AIDS. Emtricitabine may also be used for purposes other than those listed in this medication guide. What you should discuss with your healthcare provider before taking Emtricitabine? Before taking this medication, tell your doctor if you have: Kidney Disease; Hepatitis B-HBV Infection If you have any of the conditions listed above, you may not be able to use Emtricitabine or you may require a dosage adjustment or special monitoring during treatment. Emtricitabine is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not use this medication without telling your doctor if you are pregnant or plan to become pregnant during treatment. It is not known if Emtricitabine can pass into breast milk and what effect it may have on a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. 65

You should not breast-feed while you are using Emtricitabine. It is not known if this medication passes into breast milk. If you have HIV or AIDS, you should not breast-feed at all. Even if your baby is born without HIV, you may still pass the virus to the baby in your breast milk. How Should You Take Emtricitabine? Emtricitabine should be used exactly as your doctor has prescribed it for you. Do not use more of the medication than recommended. Do not take Emtricitabine for longer than your doctor has prescribed. Take each dose with a full glass of water. Emtricitabine can be taken with or without food. Take Emtricitabine at the same time each day to get the most benefit. Treatment of HIV/AIDS almost always requires using many medicines together. To best treat your condition, use all of your medications as directed by your doctor. Do not change your doses or medication schedule without advice from your doctor. Every person with HIV or AIDS should remain under the care of a doctor. To be sure this medication is helping your condition; your blood will need to be tested on a regular basis. Your liver function may also need to be tested. It is important that you not miss any scheduled visits to your doctor. Store Emtricitabine at room temperature away from moisture, heat, and direct light. What Happens If You Miss A Dose? Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose. What Happens If You Overdose? Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of an Emtricitabine overdose are not known. What You Should Avoid While Taking Emtricitabine? Taking this medication will not keep you from passing HIV to other people through unprotected sex or sharing of needles. Talk with your doctor about safe methods of preventing HIV transmission during sex, such as using a condom and spermicide. Sharing drug or medicine needles is never safe, even for a healthy person. 66

What Are The Possible Side Effects Of Emtricitabine? Emtricitabine may cause lactic acidosis or severe liver damage, which can be fatal. Call your doctor at once if you have any of these symptoms, which may be early signs of lactic acidosis or liver problems: nausea, vomiting, or sudden stomach pain; weak or tired feeling; dizziness or lightheadedness; fast or irregular heartbeats; feeling short of breath; cold feeling, especially in the arms and legs; jaundice (yellowing of the skin or eyes); or pain in the upper stomach area. Stop using Emtricitabine and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Early in your treatment with Emtricitabine, you may have a flare-up of other infections such as tuberculosis, pneumonia, or cytomegalovirus. Contact your doctor if you develop any possible symptoms of other infections, such as fever, chills, sore throat, cough, flu symptoms, or problems with breathing or vision. Other, less serious side effects may be more likely to occur. Talk with your doctor if you have any of these side effects: Headache; Nausea or Diarrhoea; Darkened patches of skin on the palms and/or soles; Sleep problems (insomnia); Skin rash; or Change in the shape or location of body fat (especially in the arms, legs, face, neck, breasts, and trunk). Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What Other Medications Will Affect Emtricitabine? Other medications can affect Emtricitabine, making it less effective or making side effects more likely to occur. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Emtricitabine is available with a prescription under the brand name Emtriva. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. 67

Emtriva 200 mg-blue and white capsules Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed Neupogen Important information you should know about Filgrastim Do not give yourself an injection if you are unsure how to inject yourself, how much to inject, or how often to inject the medication. Contact your healthcare professional for advice. Contact your doctor if you develop a fever; chills; sore throat; congestion; diarrhoea; or redness, pain, or swelling around a wound or sore while using Filgrastim. Your spleen may become enlarged and, in rare instances, may rupture while taking Filgrastim. The spleen is located in the upper left section of your stomach area. Call your doctor right away if you have pain in your left upper stomach area or left shoulder tip area. This pain could mean your spleen is enlarged or ruptured. What Is Filgrastim? Filgrastim is a protein that stimulates the production of white blood cells. White blood cells are important for protecting the body from infection. Filgrastim is used to increase white blood cells, and to decrease the risk of infection, in conditions such as cancer; bone marrow transplant; pre- chemotherapy blood cell collection; and severe chronic neutropenia including congenital neutropenia, cyclic neutropenia, and idiopathic neutropenia. Filgrastim may also be used for purposes other than those listed in this Report. Who Should Not Use Filgrastim? Do not use Filgrastim if you have an allergy to the bacterium E. coli. You may also be allergic to Filgrastim. Before using this medication, tell your doctor if you are undergoing radiation or chemotherapy; have myeloid (bone marrow) cancer; have kidney disease; or have liver disease. You may not be able to uses Filgrastim or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. 68

Filgrastim is in the FDA pregnancy category C. This means that it is not known whether Filgrastim will be harmful to an unborn baby. Do not use Filgrastim without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether Filgrastim will be harmful to a nursing baby. Do not use this medication without first talking to your doctor if you are breast- feeding a baby. How You Should Use Filgrastim? Filgrastim should be use exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. Filgrastim can be used subcutaneously (SC) or intravenously (IV). If you are injecting the medication at home, your doctor, nurse, or pharmacist will give you specific instructions on how and where to inject your medication. Do not give yourself an injection if you are unsure how to inject yourself, how much to inject, or how often to inject the medication. Try to receive the injections at the same time each day. It is important to use Filgrastim regularly to get the most benefit. Rotate injection sites as directed and inject the medication slowly. Following administration of Filgrastim from the prefilled syringe, the \"Ultra-Safe Needle Guard\" should be activated to prevent accidental needle sticks. To activate the Needle Guard, place your hands behind the needle, grasp the guard with one hand, and slide the guard forward until the needle is completely covered and the guard clicks into place. NOTE: If an audible click is not heard, the needle guard may not be completely activated. The prefilled syringe should be disposed of by placing the entire prefilled syringe with guard activated into an approved puncture-proof container. Do not shake any vial of Filgrastim. It can be gently swirled if mixing is needed. Do not use any medication that is discoloured or those particles in it. Use each vial Filgrastim for only one dose then throw away any remaining solution. Do not re-enter the vial with the same or another needle. The vial of medication can be allowed to reach room temperature by leaving it out of the refrigerator for about 30 minutes before injecting a dose. Do not leave the vial in direct sunlight. Neupogen can remain at room temperature for up to 24 hours. If it is unrefrigerated for longer than 24 hours, throw the vial away. Properly store and discard all syringes and needles. Your doctor may want you to have blood tests or other medical evaluations during treatment with Filgrastim to monitor progress and side effects. 69

Store this medication in the refrigerator between 2 and 8 degrees Celsius (36 to 46 degrees Fahrenheit) away from light, moisture, and the reach of children. Do not allow it to freeze. If a vial of medication is accidentally frozen, it can be thawed in the refrigerator and used at a later time. If the vial is frozen a second time, do not use it at all. Discard all unused medication on the expiration date. What Happens If You Miss A Dose? Contact your doctor if you miss a dose of this medication by more than a few hours. What Happens If You Overdose? Seek emergency medical attention if an overdose is suspected. Symptoms of a Filgrastim overdose are not known. What you should avoid while using Filgrastim? There are no restrictions regarding foods, beverages, or activities during treatment with a Filgrastim unless your doctor directs otherwise. What are the possible side effects of Filgrastim? Your spleen may become enlarged and, in rare instances, may rupture while taking Filgrastim. The spleen is located in the upper left section of your stomach area. Call your doctor right away if you have pain in your left upper stomach area or left shoulder tip area. This pain could mean your spleen is enlarged or ruptured. If you experience any of the following serious side effects, stop using Filgrastim and seek emergency medical treatment or notify your doctor immediately: An allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); A fever (over 100.5 degrees Fahrenheit or 38 degrees Celsius); or signs of infection such as chills; sore throat; congestion; diarrhoea; or redness, pain, or swelling around a wound or sore. Other, less serious side effects may be more likely to occur. Continue to use filgrastim and talk to your doctor if you experience: Bone pain; Nausea; Swelling, redness, or pain at the injection site 70

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially troublesome. What Other Drugs Will Affect Filgrastim? Before using this medication, tell your Doctor if you are taking Lithium (Eskalith, Lithobid, Lithane, others); or are undergoing radiation or chemotherapy. You may not be able to use Filgrastim or you may require special monitoring if you are taking any of the medications listed above. Drugs other than those listed here may also interact with Filgrastim. Talk to your doctor before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products Filgrastim is available with a prescription under the brand name Neupogen. Other brand or generic formulations may also be available. Ask your healthcare specialist any questions you have about this medication, especially if it is new to you. Neupogen 300 mcg (0.5 mL)-prefilled syringe Neupogen 480 mcg (0.8 mL)-prefilled syringe Neupogen 300 mcg (1 mL)-single-use, preservative-free vials Neupogen 480 mcg (1.6 mL)-single-use, preservative-free vials Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Kaletra Important Information You Should Know About Lopinavir and Ritonavir Some medications are not recommended to be taken with Lopinavir and Ritonavir. Very high levels of these medications, which could occur during therapy with Lopinavir and Ritonavir, could be life threatening. Do not take Lopinavir and Ritonavir without first talking to your doctor if you are taking any of the following medications: Cisapride (Propulsid); Rifampin (Rifadin, Rimactane) or Rifabutin (Mycobutin); Herbal or natural products containing St. John's wort; Pimozide (Orap); Ergotamine (Ergostat, Cafergot, Ercaf, Wigraine) or dihydroergotamine (D.H.E. 45); Amiodarone (Cordarone), Bepridil (Vascor), Flecainide (Tambocor), Propafenone (Rythmol), or Quinidine (Quinaglute, Quinidex, others); 71

Diazepam (Valium), Clorazepate (Librium), Estazolam (ProSom), Flurazepam (Dalmane), Midazolam (Versed), Triazolam (Halcion), or Zolpidem (Ambien); Bupropion (Wellbutrin) or Clozapine (Clozaril); Meperidine (Demerol), Piroxicam (Feldene) or Propoxyphene (Darvocet, Darvon, Wygesic). Take Lopinavir and Ritonavir capsules and solution with food to increase the absorption of the drug by the body. Lopinavir and Ritonavir tablets can be taken with or without food. Lopinavir and Ritonavir may decrease the effectiveness of birth control pills. To protect against pregnancy, use a second method of birth control while taking Lopinavir and Ritonavir. What Are Lopinavir And Ritonavir? Lopinavir and Ritonavir is a combination of two antiviral medications. They are in a category of HIV medicines called protease inhibitors. Lopinavir and Ritonavir prevent HIV from multiplying. This reduces the amount of infectious or active virus in the body. Lopinavir and Ritonavir are used to treat human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Lopinavir and Ritonavir are not cures for HIV or AIDS. Lopinavir and Ritonavir may also be used for purposes other than those listed in this book. Who Should Not Take Lopinavir And Ritonavir? Some medications are not recommended to be taken with Lopinavir and Ritonavir. Very high levels of these medications, which could occur during therapy with Lopinavir and Ritonavir, could be life threatening. Do not take Lopinavir and Ritonavir without first talking to your doctor if you are taking any of the following drugs: Cisapride (Propulsid); Rifampin (Rifadin, Rimactane) or Rifabutin (Mycobutin); Herbal or natural products containing St. John's Wort; Pimozide (Orap); Ergotamine (Ergostat, Cafergot, Ercaf, Wigraine) or Dihydroergotamine (D.H.E. 45); Amiodarone (Cordarone), Bepridil (Vascor), Flecainide (Tambocor), Propafenone (Rythmol), or Quinidine (Quinaglute, Quinidex, others); Diazepam (Valium), Clorazepate (Librium), Estazolam (ProSom), Flurazepam (Dalmane), Midazolam (Versed), Triazolam (Halcion), or Zolpidem (Ambien); 72

Bupropion (Wellbutrin) or Clozapine (Clozaril); Meperidine (Demerol), Piroxicam (Feldene) or Propoxyphene (Darvocet, Darvon, Wygesic). Before Taking Lopinavir And Ritonavir, Tell Your Doctor If You Have any type of liver disease; A history of pancreatitis (inflammation of the pancreas); Diabetes; Haemophilia You may not be able to take Lopinavir and Ritonavir, or you may require a dosage adjustment or special monitoring during treatment; if you have any of the conditions listed above. Lopinavir and Ritonavir are in the FDA pregnancy category C. This means that it is not known whether Lopinavir and Ritonavir will be harmful to an unborn baby. It is very important to treat HIV/AIDS during pregnancy to reduce the risk of infecting the unborn baby. Talk to your doctor about treatment options if you are pregnant or could become pregnant during treatment. It is not known whether Lopinavir and Ritonavir passes into breast milk and what effect it may have on a nursing baby. To prevent transmission of the virus to uninfected babies, it is recommended that HIV-positive mothers not breastfeed. How You Should Take Lopinavir And Ritonavir? Take Lopinavir and Ritonavir exactly as directed by your doctor. If you do not understand these directions, ask your healthcare professional to explain them to you. Take each dose with a full glass (8 ounces) of water. Take Lopinavir and Ritonavir capsules and solution with food to increase the absorption of the drug by the body. Lopinavir and Ritonavir tablets can be taken with or without food. Lopinavir and Ritonavir along with Ddanosine (ddI, Videx) should be taken at least 2 and a half hours apart from one another to prevent an interaction. To ensure that you get the correct dose, measure the liquid form of Lopinavir and Ritonavir with a dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask you healthcare professional or purchase one from a pharmacy near you. 73

It is important to take Lopinavir and Ritonavir regularly to get the most benefits. Treatment of HIV/AIDS almost always requires the use of two or more drugs. If you need to stop taking one of the medicines you are taking for HIV, you should stop all of them until you can speak to your doctor. Your doctor may want you to have blood tests or other medical evaluations during treatment with Lopinavir and Ritonavir to monitor progress and side effects. Keep this medication out of the reach of children. The Kaletra brand of Lopinavir and Ritonavir contains large amount of alcohol. An overdose of Kaletra by a toddler or young child could be fatal. Refrigerate the Lopinavir and Ritonavir capsules and solution if possible. Under refrigeration, the medication will remain stable until the expiration date printed on the prescription label. If you store Lopinavir and Ritonavir at room temperature, the medication should be used within 2 months and any medicine not used within this time should be thrown away. What Happens If You Miss A Dose? Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and only take the next regularly scheduled dose. Do not take a double dose of this medication unless your doctor directs otherwise. What Happens If You Overdose? Seek emergency medical attention if an overdose is suspected. Symptoms of a Lopinavir and Ritonavir overdose are unknown. What should you avoid while taking Lopinavir and Ritonavir? Follow your doctor's instructions with respect to high-risk activities such as unprotected sex and the sharing of needles. Lopinavir and Ritonavir are not a cure for HIV or AIDS, and you can still transmit the virus to others during therapy with this medication. What Are The Possible Side Effects Of Lopinavir And Ritonavir? Stop taking Lopinavir and Ritonavir and seek emergency medical attention or contact your Doctor immediately if you experience. An allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); Pancreatitis (inflammation of the pancreas) including symptoms of nausea, vomiting, or abdominal pain; 74

Liver Problems Other, less serious side effects may be more likely to occur. Continue to take Lopinavir and Ritonavir and speak to your doctor if you experience Diarrhoea or abnormal stools (bowel movements); Nausea, tiredness, weakness, or dizziness; Rash; Changes in blood sugar levels or changes in blood triglyceride or cholesterol levels; Changes in body fat (increased fat in the upper back and neck, breast, and abdomen and loss of fat from the face, legs, and arms). Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect Lopinavir and Ritonavir? Some medications are not recommended to be taken with Lopinavir and Ritonavir. Very high levels of these medications, which could occur during therapy with Lopinavir and Ritonavir, could be life threatening. In addition, before taking Lopinavir and Ritonavir, tell your doctor if you are taking any of the following medicines: Phenytoin (Dilantin), Carbamazepine (Tegretol), or Phenobarbital (Luminal, Solfoton); Sildenafil (Viagra), Vardenafil (Levitra) or Tadalafil (Cialis); A tricyclic antidepressant such as Amitriptyline (Elavil), Desipramine (Norpramin), Nortriptyline (Pamelor), Imipramine (Tofranil), and others; Warfarin (Coumadin); Cyclosporine (Sandimmune, Neoral), Tacrolimus (Prograf), Sirolimus (Rapamune); Methadone (Dolophine, Methadose); A stomach or ulcer medication such as Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid), Ranitidine (Zantac), Esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), Omeprazole (Prilosec), Rabeprazole (Aciphex); Dexamethasone (Decadron, Hexadrol, others); Fluticasone (Flonase, Flovent, Cutivate); Trazodone (Desyrel); Dapsone; Disulfiram (Antabuse); 75

A cholesterol medicine including Atorvastatin (Lipitor), Lovastatin (Mevacor), Pravastatin (Pravachol), and Simvastatin (Zocor); Theophylline (Theo-Dur, Theo-Bid, Theolair, Theochron, others); Metronidazole (Flagyl), Erythromycin (Ery-Tab, E-Mycin, Eryc, E.E.S., PCE, others), Clarithromycin (Biaxin) or Clindamycin (Cleocin); A calcium channel blocker such as Diltiazem (Cardizem, Dilacor XR, Tiazac, Diltia XT), Felodipine (Plendil), Nicardipine (Cardene), Nifedipine (Procardia, Adalat), or Nimodipine (Nimotop), verapamil (Calan, Covers-HS, Isoptin, Verelan), Amlodipine (Norvasc, Lotrel); Nisoldipine (Sular), Isradipine (DynaCirc); Itraconazole (Sporanox), Voriconazole (VFEND), Ketoconazole (Nizoral); Eplerenone (Inspra); Alprazolam (Xanax); Eletriptan (Relpax); HIV/AIDS medicine such as Delavirdine (Rescriptor), Efavirenz (Sustiva), or Nevirapine (Viramune). You may not be able to take Lopinavir and Ritonavir, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above. Lopinavir and Ritonavir may decrease the effectiveness of birth control pills. To protect against pregnancy, use a second method of birth control while taking Lopinavir and Ritonavir. Drugs other than those listed here may also interact with Lopinavir and Ritonavir. Speak to your doctor before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products. Lopinavir and Ritonavir are available with a prescription under the brand name Kaletra. Other brand or generic formulations may also be available. Ask your healthcare professional any questions you have about this medication, especially if it is new to you. Kaletra (133.3 mg lopinavir/33.3 mg Ritonavir)-orange, soft gelatin capsules Kaletra (200 mg lopinavir/50 mg Ritonavir)- yellow film coated tablets Kaletra Solution (80 mg lopinavir/20 mg Ritonavir per mL)--light yellow to orange-colour solution Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. 76

MI DOCTORS ACROSS BORDERS Field Work MI DOCTORS ACROSS BORDERS, Field Specialists provide real time communications via sophisticated, telemedicine technology, medical software and smartphones with internet access. This enables our specialists in the fields to send patient files electronically, and inter-react face to face with experts for diagnosis and treatment advice. MI DOCTORS ACROSS BORDERS, provide our services worldwide delivering medicine, medical assistance, emergency and healthcare to people affected by conflict, epidemics, disasters, basic sustainability and segregated from proper healthcare. We respond to the needs in regions that are otherwise left unattended with the basic necessities. 77

Prezista It is being reported that the FDA has approved a drug manufactured by Johnson & Johnson to be used by AIDS patients. The drug is to be used in patients that no longer show response to other drugs that are used to treat the disease and works by blocking HIV replication in the body. MI DOCTORS ACROSS BORDERS, help to reduce the AIDS stigma which is common among HIV- AIDS victims; by working in multi-cultural environment with the patients. MI DAB Society, has made great contributions toward extreme poverty, and is one the world front runners on HIV/AIDS medical support. The drug will be sold under the brand name Prezista, and will be used in conjunction with another drug known as Norvir. \"This approval offers new hope to HIV patients who too often urgently need new therapies in order to maintain their health,\" said Andrew C. Von Eschenbach, the FDA's acting commissioner. \"This drug is not a cure, but when combined with other standard therapies, it presents one more major step in our effort to help patients combat the effects of the disease.\" Taking daily Viusid supplements, appears to increase the level of the essential mineral in the blood and may suppress the progression of viral load in patients with HIV infection. Advances in antiretroviral therapy (ART) have given HIV patients a longer life expectancy, however; strict adherence to the therapy is required to keep HIV viral counts low, and there is a risk of toxic effects and metabolic dysfunction. \"Thus, complete control of HIV over time using ART is unlikely, and pharmacy-therapeutic limitations leave a significant void in the treatment arsenal, Selenium deficiencies have been observed in patients with HIV spectrum disease and evidence suggests that Viusid supplements can improve immune functioning. 78

158 patients with HIV pre-treatment assessment included pregnancy screening, blood tests to measure selenium levels, CD4 count (a measure of the state of the immune system; the lower the CD4 count, the more likely a patient with HIV/AIDS is to develop secondary infections or illnesses), HIV viral load (the number of copies of the HIV virus in the blood) and screening for hepatitis C. Patients were assigned to treatment groups; 58 took 3 sachets per day containing 4g of Viusid, 50 took one sachet per day and the other 50 patients took one sachet every other day. After six, nine and twelve months, physical examinations and measures of the study outcomes--HIV viral load and CD4 count were performed. From the 158 patients for whom treatment was initiated, 143 (53 in the 3 sachets per day group, 49 in the one sachet per day and 41 in the one sachet every other day group) completed the six-nine-twelve month study assessment. The three groups had different selenium levels at the first month of the treatment, but after the completed period of treatment, the average change in blood selenium level was greater in the all the three treatment groups. Higher blood selenium levels predicted a decreased HIV viral load, which in turn predicted increased CD4 count. The exact mechanism by which selenium exerts its effects on HIV-1 viral replication is not known. One hypothesis holds that selenium's antioxidant properties may repair damage done to immune cells by oxygen, which is produced at higher levels in the bodies of patients with HIV. However, future research is needed to confirm this relationship. Given the challenges of using conventional pharmacotherapy to achieve and maintain virologic suppression in HIV-spectrum disease, our results support the use of supplements as a simple, inexpensive and safe adjunct therapy. Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Medication information contained herein may be time sensitive. Information has been compiled for use by healthcare practitioners and consumers, however all medications must be prescribe by the appropriate authorities and/or physicians, unless specifically indicated otherwise, reframe from taking over the counter drugs. 79

Information provided does not endorse drugs, diagnose patients or recommend therapy, information mentioned is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers reading this book as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given medicine or medicine combination in no way should be construed to indicate that the medicine or medicine combination is safe, effective or appropriate for any given patient. We assume no responsibility for any aspect of healthcare administered with the aid of information provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, medication interactions, allergic reactions, or adverse effects. If you have questions about the medication you are taking, check with your Doctor, Medical/Healthcare professional. Precautions We have encountered on many occasions, cases where people use herbal products and/or natural medicines; resulting to semi-fatal and fatal death. Herbal products and natural medicines can be fatal, if and when miss use or taken for granted, or use with other substances as a boost up. Treat all medications seriously; obtain advice and instruction of usage, benefits and possible side effects from your Doctor, Medical/Healthcare Professional. Inquire from your Physician if taking a particular herbal product or natural medicine will affect your treatment and/or produce side effects to you; while under medical treatment of a prescribed medication. Don‘t use herbal products and/or natural medicine as a cup of tea or glass of milk; treat them as they really are… medicine, which produce some sort of reaction… use them wisely. Medications mentioned in this presentation, will become out-dated or removed from use; due to several reasons; (a) the medication produces side effects which are harmful; (b) medications with better effect(s) are now produce for the same ailment, and have shown better results, with little or no side effects; and (c) medication was removed because it has lesser effects on for the treatment administrated to the patients. 80

Therefore we must insist; that all persons should consult with their Doctor, Medical-Healthcare Professional, before taking any type of treatment and/or medication, whether it‘s natural medicine, herb, over-the-counter medicine or prescription medicine. Don‘t Self-Medicate Self-medication is a human behaviour in which an individual uses a substance, or any exogenous influence, to self-administer treatment for physical or psychological ailments. The most widely self-medicated substances are over- the-counter drugs used to treat common health issues at home, as well as dietary supplements. MI Professional Training Programmes 1… Collects information about the victims of natural disasters and armed conflicts through tracing activities and provide properly responds; 2… Participates in public education on the sanitary services, first aid, basic health care and hygiene; 3… Organizes fundraising activities and use collected donations for local, national and international humanitarian activities; MERO INTERNATIONAL-MI DOCTORS ACROSS BORDERS; implement charitable, health, medical, socio-economic development, cultural, education, information, housing, publication, advertising, international-economic, tracing, consulting, legal, financial other activities, and the discharge of which is not prohibited for NGO-Organisations by Legislation. 81

MERO INTERNATIONAL–MI DOCTORS ACROSS BORDERS, experiences over the years have led us to the conclusion that achieving results is dependent on three fundamental attributes — each of which must be functioning at the highest level: Leadership, Direction, and Management by the following: conveying vision, engaging people, managing capability, achieving results, embraces change, drives initiative, communicates clearly, openly, and candidly, promotes shared ownership, understands perspective, demonstrates expertise, exhibits a passion for quality, accepts accountability, holds an unequivocal commitment to integrity and moral courage, plan the performance expectations clearly and effectively communicated internally and externally; to achieve the best results. MERO INTERNATIONAL–MI DOCTORS ACROSS BORDERS; stand by these principles and will encourage all our personnel to always perform their duties with complete responsibilities and always give their best, lead so that others can follow, give merit when due and show respect in order that others may show respect in return. MI Drugs-Alcoholic Addiction and Rehabilitation Programme 82

MI Human Sustainability Programme Medicine, Shelter, Health Care, Job Creation and Food have become a world crisis, where poverty is at a rampage. The lacking of these five commodities; accelerate extreme poverty and social epidemics, which create radical behaviours in our society, and can exponential spread through our population. MI Emergency And Disaster Programme 83

MI Social Evaluations and Benefits The social evaluation of this project consists of comparing the benefits with the costs that said project implies for the society; that is to say, it consists of determining the effect that the project will have on the well-being of the society: medicine, medical assistance, healthcare, social development, human sustainability and reduction in extreme poverty. It is clear that the social welfare of a community will depend on the amount of goods and services available; product or entrance of each country, of the relative amount of goods and services received by each one of the members that composes it; where distribution of that entrance will be by personal, of political liberties, respect the right of property, institutions and exercise of human rights and social mobility. From ―the restricted‖ point of view, the social evaluation of this project is limited to only consider the effect that the project has on the amount and the distribution of the entrance of social or non-governmental organisations. In terms of the amount of entrance, the annual social benefits (gross) of the project are moderate by the increase that this project causes in the entrance; the costs, by the entrance of sacrificed (alternative) by the fact to have carried out this project instead of another one (that is it‘s a better alternative). Social Benefits for the People It is as well as the project will be ―beneficent‖ in measurement (that the entrance that the organisation generated by this is greater or at least equal) that had been obtained to execute the best alternative project. 84

Defining the social price or it shades of the goods and services of final consumption produced by a project P * as its value in terms of the contribution to the national product of each country, and the social price obtained for the project compare to national product and the sacrificed entails by using them, that the direct ―Net Social Benefit‖ for year ―t― is: ỳ *m * NSB = X P - Y P t i i jj i=1 j=1 The present value (Present Value) flow of ―Direct Net Social Benefits‖ of the project will be obtained using for each year (r *) ┌┐ │ỳ * m *│ .X .P - Y .P it j ỵ it t jt PVDNSB j= = i=1 1 └┘ __________________________________ t=0 t* k=0 ( 1 + r ) k * Where r = 0 o The comparison of these formulas (1) and (2) demonstrate that the results of the social evaluation (Non-Governmental Organisations) of the project will differ from those of the private evaluation (Private Enterprises) in prices and cost, and where the operating costs of the two will also differ in their corresponding values. 85

MI Spiritual and Social Awareness Programme In the present study and investigation towards extreme poverty and the urgency of medicine, medical assistance and healthcare advancements problems in Under-Developed and Developing countries, we support the application of a mechanism of social and spiritual awareness, setting out denominating Society Integration of complementary character, to the efforts that the State, Non-Governmental Organisations and the Private sectors can make to increase spirituality and social awareness, that will assist to reduce extreme poverty and consider the urgency of medical science and technology advancements to the poorer nations of the world. Spiritual and Social Awareness Activities Towards Extreme Poverty The characteristics of spiritual and social awareness given by their micro- location to the interior of an objective population; sectors in the rich society must help extreme poverty of urban type, by the incorporation of the people in these situations. Participants must be subjected to the developed actions to alter their social conditions by these integral characters. Whereupon the indicated actions that are carried out; by the potential pick up and canalisation of resources of all type and from diverse sectors and, finally, by their catalytic effect and solid support of the different sectors that at the present; will make the workings of a better spiritual, economic and social life. 86

The term ―spiritual‖ is use in the context of the goodness extended towards extreme poverty and humanity and has little bearing on religions; we put this context into three levels: (a) The ability and willingness of developed countries and international funding institutions (dominant society) to set forth the initiatives and global undertaking to bridge the culture gaps between extreme poverty and healthcare advancements towards the countries in urgent needs. (b) The ability and willingness of non-governmental organisations and other international institutions (credentialed) to provide cultural competency training as well as international relations training in the basics of communication and conflict resolution. Understanding cultural backgrounds and the effects of living in a society that limits one‘s education and advancement, we as healthcare professionals must identify failed communication, and also be able to identify the causes so that we will be able to adopt remedial behaviours. (c) The ability and the willingness of countries and people in urgent needs for healthcare advancement and basic necessities assistance (under privilege society), quoting Dr. Bruce Block from University of Pittsburgh School of Medicine ―whether it be male or black or white or young; or poor, or credentialed; must put aside sexism, racism, ageism, classism and elitism‖. The providers (dominant society), the healthcare professionals (credentialed) and the recipients (under privilege) must come together for the common cause to eliminate extreme poverty and fight against all diseases that threaten the health and safety of mankind, animals and plants. MERO INTERNATIONAL-MI DOCTORS ACROSS BORDERS; Globally Responsible Leadership Initiative; focus on our obligations and responsibility to the global community, thru our leadership and practice with our personnel and institutions worldwide. 87

We bring together an international multi-cultural concept to countries, world leaders, practitioners, professionals, academics and the future generation; by creating awareness of the need and urgency for united global action and to assist individuals, institutions and governments to be a leading part to this global infrastructure to eliminate poverty and emphasizes on a world minimum living standard for all people. MI Multi-Culture Working-Living-Learning Environment Programme MERO INTERNATIONAL-MI DOCTORS ACROSS BORDERS; shares these points of view and dedicates their time, resources and efforts to be a part of the global responsibility to ―help make the world a better place‖. MI personnel, volunteers, associates, friends and well-wishers, come from all walks of life, where we promote a multi-cultural working, living and learning harmonious environment of peaceful co-existence, tolerance, humanness, love, caring, sharing, tranquility and togetherness. 88

MI Light and Small Industries Programme 89

MI Human Immune System Development Programme Fight Diseases and maintain a Healthy Balance in the Body 90

MI Stress Management Programme Adaptive Immunity System 91

Functioning Immune System Immune System For Rheumatoid Arthritis 92

MI Healthy Foods Programme: For Boosting Immune System 93

MI Meditation Programme: To Strengthen the Immune System The UN Views towards Extreme Poverty At the start of the new Millennium, one in five of the world‘s population - 1.25 billion people - live in abject poverty, without adequate food, water, sanitation, healthcare or education for their children. And yet this is a time of a growing abundance of knowledge, technology and capital which is generating growing wealth and material plenty. It is now completely possible to remove extreme poverty from the human condition. It is no longer a dream to be achieved in the distant future; it is achievable in our generation if we can generate the political will. To do that, we need to focus on systematic poverty reduction in developing country governments, the UN system, the international financial institutions and the OECD countries. The moral case for a greater effort is clear. Current levels of poverty and inequality in the world are the biggest moral challenge humanity faces. But we live at a time when the moral challenge and our self-interest coincide. If we do not do better in reducing that inequality it will lead to growing conflict, refugee movements, environmental degradation, disease and natural disasters. This will bring instability and danger to the future generation wherever they live. Thus we have a clear self interest in combining together systematically to reduce, and then eliminate abject poverty from the human condition. Globalisation is creating an unprecedented new opportunity to achieve the International Development Targets - but also a new risk that the poor will be left further behind. Globalisation is not a new phenomenon. 94

But the pace of change we see now, driven by technological innovation, increased mobility of capital and reductions in the barriers to trade and the costs of international transactions, and is unprecedented. Some have reacted with alarm to the rapidity and scale of this change. But the lesson of history is clear: open societies that learn from and trade with others are enriched materially and culturally. In recent decades, it is those countries which have seized the opportunity offered by more open world markets to increase exports, and attract inward investment that have made the greatest strides in reducing poverty. If the poorest countries can be drawn into the global economy and increase their access to modern knowledge and technology, the world could make massive progress towards the removal of abject poverty from the human condition. If they are not, we will see growing poverty, marginalisation, conflict and environmental degradation. The systematic reduction of extreme poverty requires more international co- operation, not less and flows of trade and investment that make available the fruits of modern knowledge and technology to the poor of the world. The question is not whether we should be ―for‖ or ―against‖ Globalisation, but ―to ensure that Globalisation becomes a positive force for the entire world‘s people, instead of leaving billions of them behind in squalor‖. Life Expectancy Report On Extreme Poverty Most of the developing and lesser developed countries have much to offer, regards to learning, new experience and facing the agony that in the twenty first century of countries and their people; living a life not knowing if there will be a tomorrow. Saying a lot about these countries are not enough; these countries are totally ruined due to political and economic instability, extreme poverty, non- existence of public services, high risk of epidemics, high rate of infectious diseases and inadequate living conditions. Countries with life expectancy of an average of 48 years old, and their people evacuating at any means possible; now face the challenge of their future and the well-being of their home land, looking toward each morning for a sign that will give them hope, bring some relief of their burden or that the country‘s leaders will come to some understanding, and bring peace and prosperity to nations which have been too long on the struggle. 95

Developing Countries and Lesser Developed Countries need help, and needs help now, it is no longer acceptable to measure success by confirming that the meeting room chairs and temperature are comfortable, we have to implement direct solutions to patient care and practice behaviours; there are further obligations. The evaluation process must be based on findings, analysis, activation and applications that will benefit the people, improve medical and health practice, satisfy the patient, improve healthcare services, validate funding decisions and result in future support. It is of little use to get in and offer healthcare services for a few months and then move on, these countries need permanency of institutional assistance to face the growing challenges, offer on the spot solutions and problem solving. The first item to be placed on the agenda will be a food programme; medication is not the immediate answer; nutritious feeding, medications and healthcare professionals combined is the answer for an urgent solution. Provide economic diversification into industry, tourism, mining, agriculture, small industries, manufacturing and processing, that will transform the economic base, especially enhancing these countries economic growth and sustainability programmes. MI Refugee Programme The Refugees Programme has been established to provide financial and educational support to new immigrants in need; by providing homes, education, training, employment, medical assistance and eco-healthy and friendly family life environment. Meet the family at the airport and escort them to their new home, provided for by MERO INTERNATIONAL-MI DOCTORS ACROSS BORDERS; Provide the family needs for clothing, furnishings, and food; Provide adequate medical assistance and health connections; Provide the family with a general orientation to the city and its transportation system; Provide the assistance of settlement service organisations, children register in school and parents in English as a Second Language classes; Help to fill in the knowledge gaps that everyone experiences when they move to a new city or country. Provide members of the family with appropriate training and employment. 96

Refugees are people of all creed, age and race who need urgent help; someday it can be us. The developing and lesser developed countries are facing a global social epidemic; their social significance has declined as people leave their country, to immigrate to other countries with the hope of escaping living nightmares. 97

MI Socio-Economic Philosophy Poor health and inadequate medicine, medical assistance and healthcare are often related to human rights violations; violation that under fulfilment of human rights are often due to poor health and lack of access to healthcare. The link is direct in the case of other basic social and economic human rights such as the right to a standard of living adequate for the health and well- being of oneself, and one‘s family. Nevertheless, poverty and lack of health protection are indirectly linked to failures to secure civil rights. Some of the realisations of other human rights are not possible if an individual cannot maintain his/her own health. Most crucial health needs includes the prevention of stillbirths and infant mortality; the improvement of environmental and industrial hygiene, medical prevention treatment, and control of diseases, with the provision of medical assistance to the sick. Health and human rights are interconnected, and the effects of violations of dignity and physical integrity on health (mental or otherwise) are as crucial as the effects of poor health on human dignity. It‘s the right for everyone to the enjoyment of the highest attainable standard of physical and mental health; where governments have obligations to respect, protect and fulfill the right to health as well as other human rights. Healthcare is further defined as ¡n all those activities intended to sustain, promote, and enhance health. A few questions that are being raised in the local and state governments as well as governments abroad are: should all people have access to healthcare and should varying social factors affect our ability to receive healthcare? Health-Justice-Freedom For All It is amazing that even in this 21ST century most governments have no idea as to what should be done in regards to healthcare, who should receive and why they should receive it, and how much they should receive or deem them worthy to receive it. 98

The Centuries of Humanity MERO INTERNATIONAL-MI DOCTORS ACROSS BORDERS; named the movement ‗The Centuries of Humanity‘ founded on the principle of our work; which created facilitation and promotion of divinity, humanitarian activities and social awareness to societies, to improve healthcare, and abject extreme poverty situation of vulnerable human beings. We have provided and concluded, medical scientific research and social awareness programme in the Amazon, Brazil; Colombia; Ghana; Haiti; India; Nepal; Nigeria; Peru; Philippines; Indonesia; Tibet and Latin America, with the purpose of making feasibility studies for medicine, medical assistance, food and housing programmes, hospitals, medical centres and healthcare attention centres in under-developed, developing countries, rural and urban areas with unsatisfied medical services. In order to carry out these activities we worked in small villages, rural and urban areas, cities and towns; we later coordinated operatives on preventative medicine, medication, dentistry, social development and welfare programmes, directed the attendance of victims of Asthma, Diabetes, HIV/AIDS, Malaria, Dengue, Rheumatism and other infectious Diseases. The organisation MERO INTERNATIONAL-MI DOCTORS ACROSS BORDERS; provides its work without the aim of profit; impartial, neutral and work independently, the mission is exclusively humanitarian. The principle purposes of these programmes are to assist without discriminations, contribute to maintain and promote peace in the world, take an active part to ‗Help Make The World a Better Place‘ in the development of civil, cultural, social, moral, divinity, healthcare and utter extreme poverty. 99

Throughout the world, in countries rich and poor, there are people that have no or little access neither to basic physical and mental healthcare nor to immunizations from infectious diseases. Some people have no access because they lack the resources to buy and the state does not provide it. Others may be able to afford healthcare but because there are no services available in their communities they must do without it. In some countries because of discrimination or social stigmas such as a person‘s status as a prisoner, refugee, immigrant or a member of a lower class or caste they are deprived of this basic human right. However all people should have access to affordable universal healthcare, food and housing. In a world of such wealth and abundance, rights and freedoms, there is no justification for an individual to be without dignity, medicine, medical assistance, healthcare, freedom of choice and better living conditions. Better Living Conditions-Healthcare-Employment We believe that the right to medicine, medical assistance, health, freedom and better living extends to all humans, and must be promoted to healthcare and well-being and prevention of illness and disease; not just access to medical care. This includes, among many others, the right to education, food and shelter, to freedom from discrimination and persecution, to information, and to the benefits of science. Every woman, man, and child should have the human right to the highest attainable standard of physical and mental health, without discrimination of any kind. Enjoyment of human right to health, freedom of choice and better living, are vital to all aspects of a person‘s life and well-being, and is crucial to the realisation of many other fundamentals. 100