Elizabeth Shepherd and Michael Occhipinti at the HeidOut

Saturday, June 29th, 2019 – The HeidOut Restaurant in Cranbrook

Elizabeth Shepherd and Michael Occhipinti

I remember a conversation I had many years ago with the British Singer / Songwriter Martyn Joseph.  His home base was in Wales. I never thought of Wales as the center of British pop culture but he assured me that it was the perfect place to call home. A significant number of major British population centers are only a couple of hours away by car. In any given week he could play  as many gigs as he liked without the risk of saturating his audience with too many repeat performances. In terms of numbers he had access to a huge audience. Financial compensations were enough to cover expenses and provide for a reasonable income. The bonus is the ability to have a normal family life style.  For variety he could hop on a plane and do short tours into the major population centers of Holland, Germany or Denmark and not be away from home for any extended periods. By and large Canadian performers are not so lucky. By comparison the distances between population centers are  huge, weather conditions forbidding and audience numbers small (by comparison). Financial compensations often barely cover expenses and with all the touring family life must take a beating.  Case in point is this current tour by Elizabeth Shepherd (vocals and piano), Michael Occhipinti (guitar), Mark Nelson (drums) and Jon Wielebnowski (electric Bass guitar). To play the gig in Cranbrook they left Chilliwack first thing in the morning, drove all day, performed that night, then onto Calgary next day to catch planes back to Toronto and Montreal.

Both Elizabeth and Michael are heavy hitters on the Canadian music scene. Both have numerous academic qualifications, awards and Juno nominations. Michael is from Toronto and Elizabeth is from Montreal and both performers spend the better part of their life on tour. Mark is from Montreal and Jon is from Calgary. This current two week Western Canadian tour  included a dozen back to back gigs.

      

The drummer Mike Nelson is from Montreal and it was obvious from the first down beat that he is a well schooled musician. He obtained his University Music degree in New Zealand and with his deft use of brushes, sticks, shakers and mallets he comes across as a serious percussionist.There’s “no crash and bash” here. It is all a very controlled dynamic sonic landscape supporting the two soloists.

Jon Wielebnowski is “the new kid on the block”. Literally. This is his first significant tour.

The musical vibe of the evening was a pop/jazz mix that owes much to the complex musical world of jazz and the vocal sensibilities of the  rock/pop world. In among Elizabeth’s original songs there was a sprinkling of covers such as Leonard Cohen’s Marianne and Bruce Cockburn’s Lovers in a Dangerous Time. As an aside, every time I hear that song I think of the 1982 film The Year of Living Dangerously, staring Mel Gibson, Sigourney Weaver and the brilliant Linda Hunt ……a must see film set in Indonesia in 1965. There was that quirky little original French tune Reine du Monde in the mix, the rollicking gospel inspired Doing the Good Lord’s Work, some Brazilian inspired (perhaps) vocalese, a brilliant version of the Beatles Blackbird and Bruce Cockburn’s I Wonder Where the Lion’s Are. In an ironical twist a deer wander by the window almost on queue. A movie script writer could not have written a better scene. Throughout all the music was Elizabeth’s funky keyboard offerings that, to my ear, seem to be influenced by the Cuban masters so lovingly explored by the Canadian Soprano saxophonist Jane Bunnett. Her supporting musicians are masters in their own right. Michael Occhipinti is probably one of Canada’s most notable guitarists and his accompaniments and solos, as always, were fluid and seamless additions to music on hand. Michael and has been a frequent visitor to this area and will be back here for a SummerSounds performance in Cranbrook’s Rotary Park on Saturday July 20th, 2019. He will be a member of Lester McLean’s Funk/Soul outfit. The drummer / percussionist Mark Nelson is a new name to me but he is one that we will probably hear more of in the future.  He is a very, very tasty player. As I said above, the bass player Jon Wielebnowki is the new kid on the block and looks like he is fresh out of high school. This is his first tour. He was rock solid the whole evening. Here are some images from the evening……..
  

 

  

 

 

 

                        

At the end of “the show” the band kicked back  and played through some “off of the top of the head” material and gave the audience that had remained behind some fine jazz inspired explorations.

Last, and not least, thanks must go to the management and staff of The HeidOut Restaurant for their fine food, refreshments and their support of live music.  Also the fine contributions of local promoter Louie Cupello for his unending efforts to bring live music to the area.  Thanks Louie …. this ones for you …….

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Lonesome Jim at Soul Foods

For those who don’t know the venue, Soul Foods is a restaurant located in the old Mount Baker Hotel on Baker Street in Cranbrook. The manager is a keen supporter of live music and on most Thursday evenings (6-9pm) there are live musical events. A favorite event is the open mic hosted by Keith Larsen every first Thursday of the month. Recently (Thursday, June 20th, 2019), Lonesome Jim (aka James Neve) performed two sets featuring his vocals accompanied by his stellar acoustic 6 string and 12 guitar pickings.Never one to stand still for too long he was sporting his new and improved persona. The “Willie Nelson” pony tail was gone and has been replaced by  a new taunt, trim back and sides hairstyle. The looks may change but the performance, as always, was stellar. Here are couple of photos of the new Lonesome Jim.

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YouTube pick (#34) – “Get used to it” by Douglas Francis Mitchell

This is a rare treat. An opportunity to spread the word about an exceptional local talent. Douglas Francis Mitchell is an East Kootenay singer song writer with, to my knowledge, well over a hundred songs in his repertoire. There are new songs rolling off his counter top each day. He is a topical song writer with a great belief in the need for  artists to dip into what they know best. That is, the personal experiences, the work environments, and the relationships  in the world that surrounds us. He does not write “moon, June, spoon” songs of youthful love and loss. He does not write “hurtin’ songs”. Nor does he write songs full of youthful angst. That sentiment is long gone and there is much more weighty and comedic material around to feed his creative impulses.  What he does write are clear and honest songs about events and personalities that inhabit our world. One of his most recent efforts is Better get Used to It. This came about in response to the devastating fires of last summer. The sentiment is basically one of “It doesn’t matter which way you vote, Climate Change is no joke”. The song was recorded at James Neves’s studio out at Wycliffe. Doug sings and plays guitar, Rod Wilson provides the percussion and  the sound effects. The fiddle playing and back up vocals are by Ally Blake. Murray Hayward created the video……

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Dead Flowers – it’s a long way from Boston to Kimberley

Boston to Kimberley is a long way, but then again to travel from from Portugal to Goa, India, to Boston, to Calgary to Kimberley is even further. Victor Coelho, the dusky lead guitarist and vocalist  of the band Dead Flowers can trace his family connections all the way back over that route. One must applaud the dedication of the two “Right Coast” Boston musicians who came all the way to Kimberley to perform at the Jazz and Blues Spring Concert Series. The pedal steel guitarist Dan Beller-McKenna Victor left his home back East to catch the early flight from Boston to land in Calgary at two in the afternoon. There was time to hook up with Victor and a cadre of Calgary musicians to play an engagement that night. For Saturday it was the drive down to Kimberley for the concert then on Sunday the drive back to Calgary to catch another flight back to Boston in time for the working week. That’s what I call dedication to one’s art. For the Kimberley concert the collective was called Dead Flowers and consisted of Victor Coelho (Guitar and Vocals), Dan Beller-McKenna  on Pedal Steel Guitar;  Tommy Knowles (Calgary) Bass Guitar; Dave Morton (Calgary) Guitars and Vocals; Kenton McDonald (Calgary) Drums. This was a solid Rock/Blues outfit and their excuse to perform in Kimberley was to go “Rolling Through Stones Country”. This was not a Tribute Band. There was no light show, no fog machine, no pyrotechnics, no prancing rock stars, just five musicians paying attention to what they were doing and to hell with the usual arena “show biz” stuff. For them it was just an opportunity to explore the repertoire and musical associations of the Rolling Stones. During the night there was some fine rock staples, such as Honky Tonk Woman, I’m a King Bee, Tom Petty’s Falling and the socially incorrect Good Morning Little School Girl (would anyone dare write lyrics like that in this day and age?).  There was some Buck Owens Country music in the mix and, of course, the country music Classic Wild Horses. We sometimes forget that this song is an original by Mick Jagger and Keith Richards. You can’t accuse the Rolling Stones of being just a bunch of pretty faces. Here are some images from another fine concert at the Studio 64 in Kimberley.

                                

Once again thanks must got to the organizing committee, the volunteers and the sponsors that make this wonderful series available to the people of Kimberley.

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A little side note – The music was straight ahead rock and roll but the two East Coast musicians have credentials that go way beyond the genre. Dan Bella-McKenna looked like an academic and, in reality he Teaches the history of Classical Music at the University of New Hampshire. He has a special interest in the Classical Music of the eighteenth and nineteen century. The obvious question is why the music of The Rolling Stones? and the answer is simple, he grew up with the music. What other reason could you have to play that music?

Victor Anand Coelho
Professor of Music & Chair, Musicology and Ethnomusicology
Director, Center for Early Music Studies
Faculty, American & New England Studies Program
Boston University
School of Music

He has a BA from Berkeley and a PhD from the University of California (UCLA). He has a special interest in Early Italian Music, performs and teaches Lute and has recorded and written extensively on his subjects of interest.

Now for a Blues / Rock musician doesn’t that beat all?

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Remembering John Renbourn

John Renbourn. Not exactly a household name in 2019 but back in the day (mid-1960s), his name was synonymous with the innovations in Acoustic Finger Picking guitar styles. That era was a hot bed of musical innovation for acoustic guitar players.  In the UK and Ireland the “folk music revival” of that time fostered interest in the American acoustic finger picking styles of the Rev. Gary Davis, Doc Watson, Mississippi John Hurt, Elizabeth Cotten, Dave Van Ronk, Joseph Spence, Blind Lemon Jefferson, Merle Travis and many more “roots” musician. Guitarists of today probably do not realize the extent of the volatility of the acoustic guitar scene of that era. Memories of that scene have been somewhat over shadowed by the explosive growth of the “British Rock and Roll” phenomenon and the electric guitar scene that followed shortly after. At that time acoustic guitarists were very fortunate to be exposed to the increased availability of recorded material, a huge number of touring folk musician legends, and a steady improvement in the quality of acoustic instruments. The acceptance of the guitar into the traditional folk scene was not immediate. The guitar was then considered foreign to the unaccompanied vocal traditions that were prevalent in the British folk clubs. However, a number of acoustic guitarists adapted the imported styles and created blends of techniques and musical styles to create new, unique ways of playing “folk music”. Innovators of the day included Davey Graham (the inventor of DADGAD tuning), Nic Jones, Martin Carthy, Bert Jansch and of course John Renbourn. Most of the innovators have gone and the only one still playing at the peak of his powers is probably Martin Carthy. Nic Jones is till alive but still suffering the effects of a catastrophic car accident. On March 26, 2015 at the age of 70 years John Renbourn passed away.

I was very fortunate to be in Banff on Thursday, September 26, 2001. I was coming off a back packing trip to Mount Assiniboine when I spotted a poster for a concert by John Renbourn at the Banff Centre. I was fortunate enough to land a seat no more than six feet away from John. I had smuggled in my camera and I managed to snap some illegal photos right at the end of the show. That was just before I was nailed by the usher. It was a small price to pay for the opportunity. Apart from the music the thing that struck me most about this master musician was how old looked. He must have been only in his late 50’s but he looked more like eighty. He did have a reputation for living hard and it showed when he shuffled on stage, sat down and had to physically hoist his one leg across his knee to support his guitar. That didn’t seem to impair his technical ability or his musicianship. It was a memorable concert and one that has come flooding back after viewing this attached video.

I think the video speaks for itself. There are some interesting anecdotes as well as demonstrations of John’s playing. Clive Carroll is a name that is new to me but obviously one deserving of attention. His playing ranks right up there with other modern masters and I am looking forward to hearing more of his work.

Also here is a video of John performing one of his iconic master pieces – SWEET POTATO

After viewing the videos I went looking for the photos I took on that night to add to this blog. They are buried deep in the masses of photos I have taken over the years and I have not been able to find them. But all was not lost. I did a search on the internet and lo and behold I came up with a link to my original article written at the time. So here are the photos ……

 

All in all it has been a nice reminder that there is more to guitar playing than strumming three chords.

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YouTube pick (#33) – Peter Emberley

I arrived in British Columbia, Canada in 1971, fell in love, got married and briefly moved to Halifax. While down East it was almost impossible to avoid the Celtic influence in Maritime music. The Irish expatriates, in groups like the Sons of Eiren and Ryan’s Fancy, while they recycled the songs and tradition of Ireland and Britain, they also infused their music with a healthy dose of local Canadian content. One song of note that I came across was Peter Emberley as performed by Ryan’s Fancy. Often the composer of Folk Songs are not known but in the case of Peter Emberley we know it was written by a Boiesetown, New Brunswick  farmer named John Calhoun. The song is the story of a young man born in 1863 in Alberton, Prince Edward Island . In 1880 when he was seventeen  he left Alberton to find work as a lumberman in the New Brunswick woods of the valley of the South West Miramichi.  In the winter of that year he was fatally injured at Parker’s Ridge while loading logs in a yard and he later died in Boiesetown. For over a century the song has been sung throughout Atlantic Canada and in the lumber camps of Ontario  and it has kept alive the memory and story of Peter Emberley. The melody is a variant of a popular Irish Ballad. The song spread further afield when Bob Dylan made free use of it in his  Ballad of Donald White. As a side note my paternal grandfather was killed in a similar accident in far away Australia in the early part of the 20th century so the song has a particular resonance for me. My father was five years old at the time and I never got to know my grandfather. The melody is a variant of a traditional Irish ballad and there a multitude of lyrics and versions out there but it is not well known around this area. May be it is time to change that.

 Here are a couple of versions of the song. The most recent version by the Wakami Wailers is particularly strong but The Ryan’s Fancy version is still my favorite. Strangely enough, to my ear,  Bob Dylan’s Ballad of Donald White sounds the most “authentic”. Go figure ………

 

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File under Wonderful – The possible eradication of Cervical Cancer

https://mosaicscience.com/story/rwanda-cervical-cancer-hpv-vaccine-gardasil-cervarix/

The East African country’s campaign to end cervical cancer through the HPV vaccine has had to overcome cultural taboos and rumours about infertility – but it’s saving lives.

Girls began queuing at their local school with their friends, waiting for their names to be called. Many were apprehensive. After all, most of them had not had a vaccination since they were babies. It was 2013 and a new vaccine had arrived in Kanyirabanyana, a village in the Gakenke district of Rwanda. Reached by a reddened earth road, the village is surrounded by rolling hills and plantations growing crops from bananas to potatoes. Unlike the 10 vaccines already offered to young children as part of the country’s immunisation programme, this vaccine was different: it was being offered to older girls, age 11–12, in the final year of primary school.

Three years before, Rwanda had decided to make preventing cervical cancer a health priority. The government agreed a partnership with pharmaceutical company Merck to offer Rwandan girls the opportunity to be vaccinated against human papillomavirus (HPV), which causes cervical cancer.

This was the first time an African country had embarked on a national prevention programme for cervical cancer. Could Rwanda become the first country in Africa to eliminate it?

It was an ambitious goal. Cervical cancer is the most common cancer in Rwandan women, and there were considerable cultural barriers to the vaccination programme – HPV is a sexually transmitted infection and talking about sex is taboo in Rwanda. Added to this, rumours that the vaccine could cause infertility made some parents reluctant to allow their daughters to be vaccinated.

Rwanda’s economy and history also made it seem an improbable candidate for achieving high HPV vaccination coverage. After the 1994 genocide, it was ranked as one of the poorest countries in the world. High-income countries had only achieved moderate coverage of the HPV vaccine; if the United States and France couldn’t achieve high coverage, how could Rwanda?

Worldwide, cervical cancer is the fourth most common cancer in women. There were an estimated 570,000 new cases in 2018 – and over 310,000 deaths, the vast majority in low- and middle-income countries. Sub-Saharan Africa has lagged behind the rest of the world in introducing the HPV vaccine and routine screening, which means the cancer often isn’t identified and treated until it has reached an advanced stage.

Almost all cases of cervical cancer are caused by HPV. It is one of the commonest sexually transmitted infections globally, and most of us are infected with at least one type of genital HPV at some point in our lives – usually as teenagers or young adults. In most cases the virus is harmless and resolves spontaneously without causing any symptoms such as genital warts.

There are more than 100 strains of HPV, at least 14 of which can cause cervical cancer and a range of less common cancers, including of the penis, vagina and anus. Persistent infection with two strains of HPV, 16 and 18, is responsible for 70 per cent of cervical cancer cases.

The first vaccine against HPV became available in 2006. This was the culmination of decades of work, notably by scientists in Germany, who in 1983 discovered the link between HPV infection and cervical cancer.

Ian Frazer and Jian Zhou at the University of Queensland, Australia, then jointly developed the technology that enabled the HPV vaccine. Using recombinant DNA technology, they built the shell of the virus from scratch and made an ‘empty’ human papillomavirus in the lab.

“This was something nobody had achieved before,” Frazer says. They realised this empty, non-infectious HPV could be used as a vaccine to prevent HPV and cervical cancer.

The news that there was a new vaccine which could drastically reduce the number of women getting cervical cancer went around the world. But with the excitement about the new vaccine came the realization that not all girls would have the same opportunity to receive it. It was likely that at least a decade would pass between its introduction in high-income countries and in low-income countries.

Today there are three HPV vaccines – Gardasil and Gardasil 9, made by Merck, and Cervarix, made by GSK. All are highly effective at preventing infection with virus types 16 and 18. The newest – Gardasil 9 – was licensed in 2014 and protects against nine types of HPV, which between them cause around 90 per cent of cervical cancers.

More than 800,000 people died in the Rwandan genocide, and its widespread destruction left the country devastated. Coverage of most World Health Organization-recommended childhood vaccinations plummeted to below 25 per cent. But within 20 years, the number of babies in Rwanda receiving all recommended vaccinations, such as polio, measles and rubella, had increased to around 95 per cent. Rwandans’ life expectancy more than doubled between 1995 and 2011. The Rwandan government had demonstrated the determination and thoroughness of its approach to vaccinations. Could it now have the same success with HPV?

Before the HPV vaccine arrived in Kanyirabanyana, 63-year-old Michel Ntuyahaga, a community health worker, spent weeks canvassing his village, going to each of the 127 mud-brick houses to inform parents about the upcoming vaccination campaign.

Joined by a nurse, he explained to parents that if they had an adolescent daughter, they had an opportunity for her to be vaccinated against a deadly women’s disease – cervical cancer.

“I explained to parents that the cancer is a disease and that the one measure to prevent it is vaccination,” he says.

Ntuyahaga wasn’t the only person educating the community about the vaccination campaign.

Constantine Nyiransengiyera has been a primary school teacher in Kanyirabanyana for the past 13 years. In addition to teaching maths, science, French and English, she was – and continues to be – responsible for gathering all the 12-year-old girls at the local school to educate them about the HPV vaccine.

Silas Berinyuma, a leader in Kanyirabanyana’s Anglican church for the past 24 years, preached about the importance of the vaccine for weeks before it arrived in the village. The church used drama to depict scenes of cervical cancer’s devastating impact. This continues today.

The same awareness campaign was taking place around the country – Rwanda has a network of 45,000 community health workers, volunteers who are present in every village. Bugesera is a district in the Eastern Province, not far from the border with Burundi. Billboards line roads through the district, advertising soft drinks alongside public health messages. One says: “Talk to your children about sex, it may save their lives.”

Not far off the main road is Karambi, a village surrounded by banana plantations. Toddlers roll tyres down the red-earth roads, teenagers carry handfuls of firewood on their heads, and adults herd cows and goats.

In 2013, the then 12-year-old Ernestine Muhoza was vaccinated against HPV at her school. “The teachers called just girls for assembly and told us that there was a rise of a specific cancer among girls aged 12 and that it was time for us to get vaccinated,” she says.

The Rwandan government had demonstrated the determination and thoroughness of its approach to vaccinations. Could it now have the same success with HPV?

When she went home to tell her parents about the vaccination, they’d already heard about it on the radio and via community health workers.

Muhoza’s parents readily agreed. But not every parent did. Some were sceptical. Why, they wondered, would their girls be getting vaccinated now, at this age? Why couldn’t all girls and women receive the vaccine? And rumour had it that the vaccine would make girls infertile.

Community health worker Odette Mukarumongi worked tirelessly in Karambi to counteract the rumours. “I told parents that a girl will go into constant menstruation – like endless bleeding – if she gets cervical cancer,” she says.

Mukarumongi says parents eventually “surrendered” and allowed their daughters to be vaccinated. Today, she says, parents rarely refuse, now that they can see the widespread acceptance of it in the community.

In Kanyirabanyana, Ntuyahaga worked similarly hard to convince parents that the vaccine wouldn’t stop their daughters from being able to conceive.

“Parents had heard that the vaccine made girls infertile. We struggled to explain to them it wasn’t true – that it was better to vaccinate their daughters against the cancer because if they got it they would become infertile,” he says.

Community health workers and nurses visited homes with posters of women’s reproductive organs to show parents the damage cervical cancer could do to their daughters.

Felix Sayinzoga, manager of the maternal, child and community health division at the Ministry of Health, says: “Rwandans are really afraid about cancer so it was easy [to roll the vaccine out]. It was also about the trust the community has in the government. That was really important – the community knows that we do not bring things that are not good for them.”

The current health minister, Diane Gashumba, agrees that trust in the government has been critical in supporting the vaccine’s uptake, but admits that the rumours surrounding it were difficult to quash.

“The rumours were not anticipated. But, of course, as the HPV vaccine was a new vaccine for a new target group there were many questions.” She adds that church and village leaders, community health workers and radio programmes played an integral role in dispelling myths about the vaccine.

Despite the vaccine’s potential to save lives – millions of them – HPV vaccination has been mired in controversy and hostility, and this has heightened in recent years.

The vaccine is recommended for girls, and in some countries for boys aged 12 to 13 too, because this is before sexual activity begins, bringing the risk of exposure to HPV. This has resulted in the vaccine being linked with promiscuity – a belief that vaccinating young girls against an STI sexualises them and encourages sexual activity. There is no evidence that boys or girls who receive the vaccine have sex earlier than those who do not have the vaccine. But this concern is one of the reasons that India – a country where more than 67,000 women die from cervical cancer every year – has refused to introduce HPV vaccine into its routine immunisation programme.

Leela Visaria, social researcher and honorary professor at the Gujarat Institute of Development Research in India, says: “The underlying reason why people don’t want it [the vaccine] is the fact it’s given to adolescent girls. They fear that girls will become promiscuous.”

Parents’ concerns about the HPV vaccine have been further fuelled by false claims about its safety. This misinformation has spread rapidly, worldwide, on social media. Japan’s take-up rate has plunged from more than 70 per cent to less than 1 per cent. Coverage has also dropped in parts of Europe, such as Denmark. In Ireland, conversely, a targeted social media campaign is reversing a sharp decline in the HPV vaccination rate.

Peter Hotez, a vaccine scientist and dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas, agrees that there is a problem in the fears that the vaccine sexualises young girls. “The other problem is that the anti-vax movement has been making false assertions about it – claims that it leads to autoimmune diseases and paralysis.

“I think the movement is attempting to draw a line in the sand and say, ‘no more vaccines’ and when something like HPV comes along they are throwing everything they can at it. It’s having a devastating impact. I worry that we will start to export this garbage and it will impact vaccine uptake in Africa.”

“Initially, when the HPV vaccine was introduced in different countries, there were differences of opinion on whether to focus on HPV and how it’s transmitted, or to focus on the fact that HPV leads to cancer and this vaccine will prevent cancer,” says Mark Feinberg. He is the former chief public health and science officer at Merck who was involved with the Rwanda programme.

“Rwanda emphasised cancer prevention. It sought to communicate that the vaccine is here to protect young women from cervical cancer.”

Sayinzoga, from the Ministry of Health, agrees that policy makers made a conscious decision not to link the vaccine with sex. “For us, we didn’t associate the vaccine with sex. We rather focused on the side-effects of cervical cancer: that it can cause infertility. Sex wasn’t part of the campaign,” he says.

It’s a decision that is widely accepted by public health experts as the right one.

Ian Frazer, the immunologist who co-invented the first HPV vaccine, says: “The HPV vaccine has had a negative association. It has turned cervical cancer into an STI, which it is, of course, but we have to be careful. There is a right messaging for every country. Now we just talk about it as a vaccine to prevent cervical cancer. I think that’s the right strategy.”

In Karambi, Muhoza, who is now 17 years old, says: “You know, there are some things that cannot be talked about openly, especially when they relate to sex.”

When Rwanda and Merck signed their agreement, it meant that from 2011 the pharmaceutical company would supply the country with HPV vaccinations for three years at no cost.

As one of the world’s largest pharmaceutical companies, Merck wanted to demonstrate that it was feasible to introduce the vaccine in low-income countries in the hope that Gavi – a global health alliance to increase access to vaccination in these countries – would take note and get on board.

“Yes, Merck is a for-profit company, but our motivation was to maximize the impact of the vaccine. We wanted to find ways of enabling its innovations to be more broadly available,” says Feinberg, who is now president and CEO of the International AIDS Vaccine Initiative.

“You quickly recognise that you have a vaccine that can have such a major impact in preventing cervical cancer, and the greatest disease burden is concentrated in the world’s poorest communities. You cannot with any conscience not come forward and make the vaccine affordable and create a sustainable vaccination programme.

“The programme in Rwanda had two purposes: to get the vaccine to a population who could benefit, but also to demonstrate what was possible. Rwanda is an incredible country in its commitment to national health. If it wasn’t possible in Rwanda, we knew it wouldn’t be possible anywhere else.”

Rwanda’s decision to partner with Merck wasn’t without its critics. In a scathing letter to the Lancet, German public health researchers voiced “serious doubts” that the HPV programme was “in the best interest of the people”. A major issue, they contended, was that while the burden of cervical cancer in the region was substantial, there were far more pressing diseases to vaccinate against, such as tetanus and measles.

If it wasn’t possible in Rwanda, we knew it wouldn’t be possible anywhere else

Rwanda’s then Minister of Health, Agnes Binagwaho, replied publicly in a letter co-signed by two US researchers. They said that Rwanda already had very high vaccination rates for tetanus and measles, and asked: “Are the 330,000 Rwandan girls who will be vaccinated against a highly prevalent, oncogenic virus for free during the first phase of this programme not regarded as ‘the people’?”

Drawing an analogy with earlier opposition to antiretroviral therapy in Africa, they said that such objections were “the latest backlash against progressive health policies by African countries. When the possibility of prevention exists, writing off women to die of cancer solely because of where they are born is a violation of human rights.”

Binagwaho, now vice-chancellor at the University of Global Health Equity in Rwanda, is still scathing about the critics of the decision to rollout the HPV vaccine. “The people who have created a backlash haven’t done their homework – they don’t know our country, they don’t know that our kids are well vaccinated with other vaccines available. [The HPV vaccine is] a great tool to prevent one of the most ravaging women’s cancers. It is less costly to prevent cervical cancer and all its suffering.”

Rwanda has proved to the world that it can achieve excellent HPV vaccination coverage. The Ministry of Health reports that 93 per cent of girls now receive the vaccine.

Almost all Rwandan girls attend school, and the systematic inclusion of local and religious leaders, community health workers and teachers in the vaccine delivery strategy has proved highly effective in spreading the message about the benefits of the vaccine and combating myths.

“I think some of the biggest reasons why Rwanda has been so successful is, first and foremost, the political will and national mobilisation, and secondly, that they decided to do a school-based programme,” says Claire Wagner, a student at Harvard Medical School who formerly worked as research assistant to Binagwaho.

The success in getting girls vaccinated has boosted confidence that the country is making rapid progress towards eliminating the disease. “We are working on our goal. We put our people first,” says health minister Gashumba.

Since 2006, over 80 countries have introduced the HPV vaccine into their routine immunization programmes. The majority are high-income, from Australia to the United Kingdom to Finland. These countries also have screening programmes for HPV and are moving from the pap smear test to a more advanced test, taken every five years, that detects high-risk HPV infections before cancer develops.

In Rwanda, before the HPV vaccine was introduced in 2011, there was no cervical cancer screening available in public health facilities – a few private clinics and NGOs offered it sporadically. Along with the vaccination programme, Rwanda also launched a national strategic plan for the prevention, control and management of cervical lesions and cancer. Women are meant to undergo visual inspection of cervix with acetic acid (VIA) at their local health centre or district hospital. Done by nurses and doctors, the screening is available to women with HIV aged 30 to 50, and other women aged 35 to 45. It’s unclear how effective and widespread this screening is.

“The problem with VIA is that one in five women will be positive but only 5 per cent need to be treated. That is an enormous cost to the healthcare system,” Frazer says. “If we want quick results we need to have some type of screening programme, but there’s a lot of debate about what that should look like in the developing world and how feasible it is.”

In Bugesera, community health worker Odette Mukarumongi says the closest health centre doesn’t do cervical cancer screening. Instead, she tells girls and women that if they experience any symptoms, like pelvic pain or constant menstruation, they should go to the health centre for a check-up.

Given that most cervical cancer cases occur in women in their 40s and 50s, if Rwanda is going to eliminate cervical cancer it will need a robust screening programme that reaches all women – women who have not benefited from the vaccine.

Countries across sub-Saharan Africa and Asia have struggled to implement cervical screening programmes. Given geographical challenges, lack of funding, and competing health issues such as HIV and malaria, cervical cancer hasn’t been a priority for most policy makers. While it accounts for less than 1 per cent of all cancers in women in high-income countries, in low- and middle-income countries it’s almost 12 per cent. This is why the HPV vaccine is so critical: for girls and women in these countries it is their best – and often only – line of defence against the disease.

Another factor in the success of Rwanda’s campaign to end cervical cancer will be its ability to sustain the HPV vaccination programme. In 2014, Merck’s donation of Gardasil ended. As Feinberg had hoped, the Gavi alliance announced it would support Rwanda’s HPV programme through a co-financing model. Rwanda pays 20 cents per dose of the vaccine, and Gavi covers the remainder of the $4.50 cost. As the country’s economy continues to grow, its co-financing obligations will rise until it reaches a threshold after which Gavi support will phase out over a five-year period. Eventually, Rwanda will fully finance its HPV vaccine.

Will the country be able to afford this?

Sayinzoga from the Ministry of Health admits he’s concerned about the country’s ability to pay for the vaccine in future. “The HPV vaccine is very expensive. What we are doing annually is looking at how we can plan for the next three years. We were in need and we accepted Merck’s help. We need to invest in the life of our people,” he says.

Gashumba says the Ministry is exploring options to make the vaccination programme sustainable, such as including the vaccine in health insurance.

Whatever the challenges in the future, Rwanda has today achieved remarkably high coverage of the HPV vaccine for girls – an extraordinary public health achievement that should inspire countries around the world.

As Rwanda gears up for a new round of vaccinations later this year, the immunologist responsible for the vaccine that has saved so many women’s lives believes the world cannot be complacent. “You can’t be happy until everyone has been vaccinated,” Frazer says.

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“Human papilloma virus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus.[1] Available vaccines protect against either two, four, or nine types of HPV.[1][2] All vaccines protect against at least HPV type 16 and 18 that cause the greatest risk of cervical cancer.[1] It is estimated that they may prevent 70% of cervical cancer, 80% of anal cancer, 60% of vaginal cancer, 40% of vulvar cancer, and possibly some mouth cancer.[3][4][5] They additionally prevent some genital warts with the vaccines against 4 and 9 HPV types providing greater protection.[1]

The World Health Organization (WHO) recommends HPV vaccines as part of routine vaccinations in all countries, along with other prevention measures.[1] The vaccines require two or three doses depending on a person’s age and immune status.[1] Vaccinating girls around the ages of nine to thirteen is typically recommended.[1] The vaccines provide protection for at least 5 to 10 years.[1] Cervical cancer screening is still required following vaccination.[1] Vaccinating a large portion of the population may also benefit the unvaccinated.[6] In those already infected the vaccines are not effective.[1]

HPV vaccines are very safe.[1] Pain at the site of injection occurs in about 80% of people.[1] Redness and swelling at the site and fever may also occur.[1] No link to Guillain–Barré syndrome has been found.[1]

The first HPV vaccine became available in 2006.[1][7] As of 2017, 71 countries include it in their routine vaccinations, at least for girls.[1] They are on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system.[8] The wholesale cost in the developing world is about US$47 a dose as of 2014.[9] In the United States it costs more than US$200.[10] Vaccination may be cost effective in the developing world.[11] —–   Wikipedia

 

“Research studies have shown early signs of the vaccine’s success including: a 77% reduction in HPV types responsible for almost 75% of cervical cancer. almost 50% reduction in the incidence of high-grade cervical abnormalities in Victorian girls under 18 years of age.”

“How effective is the HPV vaccine? The HPV vaccine provides almost 100% protection from nine HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58), if all doses are received at the correct intervals, and if it is given before you have an infection with these types.”   —–   Wikipedia

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Lizzy Hoyt at Studio 64

 

Danny Boy ……. My favorite story about this song is the one told by a traditional fiddler in a concert at the Stage Door in Cranbrook. He had been busking in Toronto when some one came up to him and asked him did he know Danny Boy?

“Well yes I do”

“I’ll give you ten bucks to play Danny Boy”, and with that he dropped a ten dollar bill into the violin case.  The fiddler was not over enthused with the prospect of playing Danny Boy. It’s  an old favorite of mothers, grand mothers, Irish Tenors and Saturday night drunks and the fiddler had heard more versions than he could care to remember and he really didn’t want to be added to the list. However, ten bucks is ten bucks so he over came his hesitancy and launched into a heart rendering version of the old war horse. He thought he acquitted himself very well indeed, until the patron reached down and picked up the ten dollar bill.

“What are you doing? You wanted Danny Boy and I played it”

“Yeh, but I didn’t like the way you played it”.

That disgruntled patron should have been in the audience on Saturday night when Lizzy Hoyt closed out her concert with an unaccompanied encore of Danny Boy. It was outstanding !!!!!

Lizzy Hoyt in Concert – Stage 64, KimberleySaturday, March 23, 2019 – This is the second concert in the Spring Concert Series.

This is Lizzy Hoyt’s second trip to the East Kootenays. She was last here February 2016 to perform with the Symphony of the Kootenays at her World Premier of Canadian Folk Sketches. Lizzy on guitar, fiddle and vocals this time around was accompanied by Josh McHan on upright Double Bass and her long time guitar and Mandolin player Chris Tabbert.

From her bio…. “Lizzy Hoyt is one of Canada’s most powerful Celtic-folk artists. Known for bringing Canadian history to life with music, her songs like “Vimy Ridge”, “White Feather”, and “New Lady on the Prairie” that have garnered awards and nominations while also connecting strongly with audiences across the country. In 2013, Lizzy was awarded the Queen’s Diamond Jubilee Medal by the Governor General of Canada for her outstanding contribution to commemorating Canadian veterans and history through music.

       

Like her encore of Danny Boy the entire concert on Saturday night was outstanding. The group opened the evening with a set of foot stomping fiddle tunes followed by The Star of the County Down. In concert Lizzy offers the complete Celtic package from Fiddle tunes, well known ballads such as Out on the Mira (from Nova Scotia), The Banks of Loch Lomond and onto some original songs like New Lady of the Prairie, White Feather, and Vimy Ridge. Tucked into the mix was even the country classic Jolene. Each performance was a sparkling jewel of polished musicianship. The program choice was great, the accompanying musicians were spot on with great Bass playing by the Edmontonian jazz musician Josh McHan and Chris Tabbert playing his Russian Stalin Era Mandolin (he found in a junk shop amid a bunch of old accordions). Lizzy played and passed around her wonderful custom Collings guitar for Chris to use when she was playing fiddle. Her fiddle of choice for the evening was a Mezzo Forte carbon-fibre instrument. The only thing missing from the evening was her Celtic Harp  performances. Unfortunately the instrument was laid up and need of some repair.

Conversations in the audience indicate  that this was the best ever performance at Studio 64 and for that we should thank the organizers, volunteers and sponsors for all the dedication and good work.

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Bonus video:

Danny Boy – Lizzy with a nice guitar arrangement with moving bass lines

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