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> iConnect Africa > Vol. 2, No. 2 Volume 3, Number 1, July 2006 Contributors to this issue: Brenda Zulu, Michael Malakata, John Yarney, Ramata Soré, Almahady Moustapha Cissé, , Aida Opoku-Mensah, Mercy Wambui, Afework Temtime
News Update QUARTERLY STORY:
SPOTLIGHT: ICTs and Health
SPECIAL ANNOUNCEMENT: Highway Africa and the 2006 AISI Media Awards OUTLOOK: Features on Stakeholders
FORTHCOMING EVENTS: July - September 2006
Sierra Leone Validates the NICI Policy and Plans About 70 participants drawn from ministries, agencies, NGOs, media, civil society attended the National Information & Communication Infrastructure (NICI) Policy validation workshop organized by the NICI core group in collaboration with the Ministry of Development and Economic Planning (MODEP) and ECA on 30 June - 2 July 2006 in Freetown, Sierra Leone. Participants discussed and adopted a draft NICI Policy and Plan for Sierra Leone. ECA provided technical assistance with support from the Government of Finland for the NICI process, whose major focus is looking into the contribution of ICTs in attaining Sierra Leone’s Poverty Reduction Strategies, its “Vision 2025” and the Millennium Development Goals. Participants agreed that a validated NICI policy and plan would be presented to the highest authority for its endorsement as a national policy document. The participants also agreed to ensure political support for the endorsement of the NICI Policy and its implementation through collaboration among academia, media and civil society organizations seeking international and national partnerships and networking. The workshop proposed a national institutional mechanism to coordinate NICI activities under the Office of the President to ensure the highest priority given to the NICI activities by all concerned. More: http://www.uneca.org/disd/news/0719200601dnadisd Training course prepares Africa for the UN Internet Governance Forum A training course on Internet Governance (IG) for African policymakers was held by ECA in collaboration with the Diplo Foundation, the Global ePolicy resource Network (ePol-NET) and the Internet Corporation for Assigned Names and Numbers (ICANN). The training was aimed at developing the skills and knowledge required by policy makers to participate meaningfully in the global debate on IG and ICT for Development, as well as the use and exploitation of the Internet to achieve the MDGs. The training was held from 2–6 July 2006 at the UN Conference Centre in Addis Ababa, Ethiopia. Close to 35 African Permanent Secretaries, directors, advisors, and experts participated in the course. Countries represented included Angola, Cameroon, Egypt, Ethiopia, Gambia, Ghana, Liberia, Libya, Mozambique, Nigeria, Rwanda, Sierra Leone, South Africa, Sudan, Kenya, Tanzania, Uganda, Zambia and Zimbabwe. A second course will be delivered in late 2006 for Francophone African countries. Online courses will also be available before the end of the year. More: http://www.uneca.org/disd/ Building a vulnerable children's multimedia service in Nigeria Fantsuam Foundation based in Nigeria has launched a vulnerable children's service as part of its rural HIV/AIDS programme. This innovative project is meant to tackle prevention gaps head-on, through a community theatre project recorded on VCDs for dissemination and use in other communities. A community theatre group, comprising mostly young people is already producing education and entertainment programmes that will make a tour of the local schools. The objective of these education and entertainment videos will be to target specific children issues in health, education, physical and emotional security. The vulnerable children service comes against the backdrop of Fantsuam’s widely-appreciated ‘secure livelihoods through micro-finance and rural ICT deployment’ programmes. Source: APCnews http://www.apc.org/english/news/ Harnessing ICT Potential in Ethiopia The Ethiopian IT Professionals Association (EITPA) in collaboration with the United States Agency for International Development (USAID) and ECA held a one-day workshop on 10 July 2006 at the UN Conference Center in Addis Ababa, Ethiopia. The workshop attracted more than 750 participants drawn from EITPA members, government, private sector, and civil society organizations. The event was aimed at creating greater awareness on the potential of ICTs for Ethiopia’s development by looking at infrastructure, human resources, applications and policy. Afework Temtime (atemtime@uneca.org).
The selection and judging process of the 2006 AISI Media Awards is scheduled for completion in time for the Highway Africa Conference to be held in Grahmstown, South Africa in September 2006. Traditionally, the award ceremony is aired live on SABC-Africa as part of the Highway Africa Conference. The winners will be sponsored to attend the Conference. The
Awards were introduced in 2003 to encourage more informed coverage
of the information society and ICT-4D issues in Africa as part of
ECA’s Information Society Outreach and Communication Programme.
The Awards are aimed at individual journalists and media institutions
based in Africa that are “promoting journalism which contributes
to a better understanding of the information society in Africa. Although
the media in Africa are beginning to report on ICT issues, there is
still a wide gap in their knowledge and comprehension of the subject
in relation to development trends within their national context. For
updates on the winners and categories, click on http://www.uneca.org/aisi/mediaaward.htm
By Brenda Zulu While trade offer opportunities for women’s socio-economic empowerment and growth in Africa, it can perpetuate women’s marginalisation and gender inequalities, which in turn hamper growth and development, the ultimate goal of trade. Speaking at the forum on Information Communication Technologies (ICT), Trade and Economic held from 14-16 March 2006 at the UN Conference Center in Addis Ababa, Ngone Diop from the African Center for Gender and Development (ACGD) said that Trade was not gender neutral. She observed that Trade agreements, policies and mechanisms have different impacts on women and men.
“Gender refers to socially constructed differences in attributes
and opportunities associated with being female or male and to the
social interactions and relationships between women and men. It determines
what is expected, allowed and valued in woman and man in a given context,”
said Diop. Rather, they will perpetuate gender inequalities and the socio-economic exclusion of women and other vulnerable groups, ultimately hampering Africa’s development prospects. ICTs can play a critical role in mitigating women’s marginalisation in Trade, which is a male dominated sector in Africa. She pointed out that many various empirical studies have documented gender and women’s concerns in trade, in Africa such as Mohau Pheko 2005 and that as stated by D. Elson “the seemingly neutral macro-economic policies including trade become male biased when implemented in a social context that discriminates against women”. She explained that the structure of the social power relationships between men and women shape their access to and command over resources including: education, land, financial resources, market, information and technology, all of which being essential for women and men’s effective participation in and benefit from national, regional and international trade. Diop said that gender and trade could be analysed in three categories such as the micro level where the gender imbalances at the household level in terms of bargaining power, division of labor (burden of unpaid care work), access to and control over resources, etc affect women’s effective participation in trade. The second category was Meso level where promotion of export-oriented production in Africa export processing zones (EPZs) as a response to globalization was associated with a gender segmentation of the labour force. Diop observed that Women are over represented in low-paid, low skills export-oriented sectors such as horticultural and floricultural sectors and in fisheries. They work in unhealthy conditions. They face employment insecurity, lack of protection, gender stereotypes and sexual harassment. She said that a study in Kenya suggests that women workers in the horticultural and floricultural sectors experience harsh working conditions while living in secluded compounds far from their own villages. While women’s share in low paid work increases, their reproductive tasks/unpaid care work does not decrease, as there is no change in the division of labor in the household. Diop explained that in the third category Macro level, Trade negotiations are men’s monopoly; women’s voices remain absent in the various trade negotiations and agreements. Trade reforms advantage large and medium producers who have access to and command of information, markets, capital, and resources. Those producers are mainly men. She said reduction in tariffs and other forms of trade taxes associated with World Trade Organisation (WTO) regulations lead to: reduction of government’s spending on social services; commodification of social services (health, education) and shift of the costs the public to the private sphere (the home), leads to increase women’s invisible and unpaid burden of care work. The critical role of ICTs Diop explained ICTs are a tool for a socio-economic transformation. They can positively change the ways the socio-economic actors produce, consume, and exchange the ways they think and act. She explained that development was about positive structural changes so; ICTs are strongly related to development. As such, ICTs constitute a powerful device to mitigate the gender imbalances that constraint woman from effectively participating in and benefiting from Trade.
It is a powerful tool for women’s socio-economic empowerment.
More: http://www.uneca.org/e-trade/index.html
Telemedicine delivers medical services through multimedia (voice, video and data) and telecommunications technologies. In this issue, Iconnect Journalists investigate ICTs and E-health in Zambia, Ghana and Burkina Faso. Telemedicine Project to improve Zambia’s health delivery In this story, Michael Malakata expounds on efforts to introduce tele-medicine for the benefit of Zambia’s rural population By Michael Malakata People
living in rural areas in Zambia struggle to access timely, quality
specialty medical care primarily because specialists and physicians
are either located in urban areas or have migrated to other countries
in search of lucrative opportunities. Telemedicine or tele-health enables patients-providers to exchange information, which leads to an appropriate diagnosis and treatment plan that can then be administered by less highly trained health staff or even the patient alone. Through telemedicine, skilled hands-on treatment, such as surgery, is often conducted. In an attempt to resolve access to health care for those in rural areas, the Zambian government through the Ministry of Health selected Lundazi district and Chipata General hospitals in Eastern province as centers for a telemedicine pilot project with the University Teaching Hospital (UTH), the country’s biggest hospital. Computers, digital cameras and other telemedicine equipment bought in China have already been installed in all the three hospitals for the first phase of the project. The project is being funded by the Zambian government and the Swedish government through the Swedish International Development Agency (SIDA) and about ZK2 billion (US$ 630, 000) is expected to be spent, says the project coordinator, Collins Chinyama. “This project is likely to cushion the disparity in health care delivery system as we promote equity in health as enshrined in our health reforms policy which we are implementing now,” the Ministry of Health spokesperson, Victor Mukonka says. The special location at UTH will have doctors on call for telemedicine 24 hours daily. “Not every case (patients) will be examined in the selected sites via telemedicine but only those cases where the local medical staff have literally no idea over it,” Mukonka discloses. The Network Administrator of the project, Beaton Sibalowa, says the New Partnership for Africa’s Development (NEPAD) is considering giving financial assistance to the project for computers and other equipment. The telemedicine project in Zambia would have been functional earlier, had it not been for the government’s dissolution of the Central Board of Health (CBoH). CBoH was a board that implemented health programmes on behalf of the Ministry of Health. Its dissolution halted the project as the board’s workers were being fused into the Ministry of Health. Exploiting tele-health in Zambia, according to Robert Mtonga at UTH will offer advantages including reduction of costs by facilitating diagnosis and treatment of selected patients on sight rather than in an expensive hospital setting. In addition, specialised treatment will be administered to the patient despite their locality. Other
benefits include low mortality rates because physicians and other
medical practitioners in rural and remote areas will be able to receive
technical advice from consultation. Further, congestion in urban hospitals
will be reduced resulting in adequate bed space for urban patients
and improving the knowledge base and experience of the remote sites
of less highly trained medical staff. Should
the project become successful, Chinyama says the second phase of the
project will be implemented in Chirundu in Southern Province, Chainama
and Chongwe districts in Lusaka Province, and Mumbwa district in Central
Province. Delivering continous medical education through ICT In this story, John Yarney looks at efforts to upgrading the skills of medical personnel in Ghana through ICTs. By John Yarney There is only one reasonable option available to Dr. Ivy Osei (real name withheld) when diagnosis or management of her patients is beyond her – referring them to health facilities located 315 kilometres and 182 kilometres from her station. “Some (patients) come back with a note (from the specialist) asking you to continue management as you have been doing,” says Dr. Osei, of her referrals to two of Ghana’s teaching hospitals -- the Korle-Bu Teaching Hospital and the Komfo-Anokye Teaching Hospital. “If you had quick access to a specialist, it would help you first of all, and the patient who will not have to travel out,” she elaborates. Dr. Amo-Addae is one of the three doctors at a public hospital which serves a mining town of a population 270,000 in Western Ghana. Aside from issues relating to service delivery, there are such few doctors at her station that it is not possible for any of them to take time off to upgrade their skills. These conditions are not just peculiar to the mining town Dr. Osei serves in, but are replicated across most parts of the country. According to Dr. Ken Sagoe Director of Human Resource of the Ghana Health Service, the country presently has just about 2000 doctors to serve its pollution of 20 million. But beyond the huge disparity in relation to doctors and patients, there are other geographical gulfs. Administrators
of the Ghanaian health sector identify with the needs at the local
level in the health sector and have put in place some measures to
address these needs. One of the programmes to meet the training needs of practitioners is the Continuing Medical Education (CME) for health professionals at the local level. Implementers of the CME programme appreciate the role of ICTs in offsetting some of the setbacks encountered in the CME programme. According to Dr. Sagoe, his outfit has been working for 2 years on using ICTs to deliver training to health practitioners. They are considering the “directed approach”, where step-by-step training is put on CD ROMs, and other audiovisual formats are provided to practitioners. Users can learn, respond to questions and their answers are reviewed under different sections after each lesson. The health authorities are looking at ICTs beyond the CME. A draft policy on eHealth has been formulated. Framers of the policy have pencilled down four health sector areas in which ICTs can be integrated. They include implementation of telemedicine systems, the development of health information and management systems, the deployment of ICTs to facilitate the spread of health and medical services to rural and under-served areas and the use of ICTs to support medical education and training. Civil society organizations have also been actively pushing for the use of ICTs in health-care delivery. The Ghana Information Network for Knowledge Sharing (GINKS) the International Institute for Communication and Development (IICD) and other collaborators have been in the forefront of this campaign. While civil
society continues it’s activism for eHealth and health practitioners
wait for the benefits that the draft policies promise to bring when
it comes on stream, patients in rural communities - like the mining
town Dr. Osei serves in - still have to travel to furlong medical
facilities when the practitioner needs another opinion on diagnosis
or management.
More than 500 journalists from 40 African countries will be attending the annual Highway Africa Conference in September to discuss issues relating to the impact of the Internet and digital technologies on journalism, media and society in Africa. This year’s Highway Africa marks its 10th anniversary. Billed as the biggest gathering of African journalists in the world, the conference is being held on 11-13 September 2006 in Grahamstown, South Africa. It will be a time for critical reflection on the role that new media has played - and will play - in democracy and development. The conference will include several side events such as book launches, exhibitions, training workshops and meetings of various groups and forums. They include meetings of the South African National Editors' Forum, Southern Africa Editors’ Forum and The African Editors' Forum. During the event, outstanding media professionals and institutions who have made a mark in covering ICT-4D issues will be honored with a number of awards, including ECA’s AISI media awards. For details, categories and guidelines click on: http://www.uneca.org/aisi/mediaaward.htm For
more information visit: http://www.highwayafrica.ru.ac.za/
Delivering generic drugs via the Internet in Burkina Faso Created in 1992, CAMEG, the purchasing centre for essential generic drugs and medical goods, began operation in 1994. CAMEG uses Information and Communication Technology (ICT) to make health services more democratic. ICT greatly improves the circulation of health information and strengthens cooperation between establishments in Burkina Faso, which is ranked near the bottom of the list by the United National Development Programme. To fulfill its mission of ensuring quick and effective access to essential drugs for all, CAMEG invested in ICT. "Those investments were part of an infrastructure modernization policy," says Edmond Traoré, computer specialist for CAMEG. Continuity of service, quality, price accessibility, protection of users and guaranteed supply are ensured.
The website makes it possible for clinics and other health facilities to order products. Individuals cannot place orders. "We are a wholesale vendor. Only people who need antiretroviral drugs (ARV) can place orders," says Edmond Traoré. Clients are required to contact a doctor registered with CAMEG to obtain a prescription and possible renewals. Drugs are only delivered in strict observance of this procedure. "It is dangerous to promote the sale of drugs on the Internet without proper precautions. That would open the door to all kinds of abuse," he adds. CAMEG began delivering antiretroviral drugs (ARV) in April 1999, on the recommendation of the Heath Department. CAMEG became involved in the distribution of ARV because of the spread of HIV/AIDS and difficulties of access to treatment, in terms of cost and availability. Until then, private firms controlled the sale of ARV and the average cost was excessive. CAMEG's involvement, although limited, enabled many sick people to obtain ARV. On its part, CAMEG has made a commitment to continue negotiations with suppliers to reduce the cost of drugs even further. The use of ICTs has led to improved use of generic drugs in Burkina Faso. Increased use by the population of generic drugs has prompted the opening of new health units. The private sector can also use the services of the central drug purchasing facility. With increased demand, CAMEG has decentralised its distribution structures by opening warehouses in four regions, Centre, Hauts-Bassins, North and East. Lazare Bansé, director of CAMEG, says, "Annual sales have grown from 240 million francs in 1995 to more than two billion francs in 2004. The average annual sales increase between 1995 and 2004 was 37 millions." According to Edmond Traoré rotation of truck deliveries have been reduced, 'which will mean fewer stock disruptions and reduced gasoline use.' As a promotion tool, the web is an advertising support for CAMEG, making possible the creation of virtual marketing windows bearing a corporate identity. In this way, CAMEG has used its site to establish contacts with numerous international partners and to build cooperative structures in all parts of the world. The CAMEG site makes it possible for users to quickly find information about e.g. catalogues and pricing. By displaying this value-added information on its website, CAMEG captures the attention of potential clients. CAMEG's pioneering Internet role was recognized in 2005, when the CAMEG website www.CAMEG.net was awarded two prizes. It received a bronze Gambré for third place in the national business category and CAMEG also received a special award from the World Health Organization (WHO) as the best website in the health field. Despite this recognition, the CAMEG site does have room for improvement, including access to purchase orders online and updating of data on a regular basis.
Progress in the health field through the use of new technologies can be a reality in our countries thanks to knowledge sharing between developing countries, with professional support from international partners - because illness has no borders.
For further information contact iConnect coordinator Sylvestre Ouédraogo,
sylvestre.ouedraogo@univ-ouaga.bf ICT and Health: Tele-radiology, a cure for a shortage of specialists By Almahady Moustapha Cissé Mali, one of the poorest countries in the world, is in the midst of solving a health specialist crisis, especially radiologists, through the use of tele-radiology. Launched in 2005, thanks to a four-year funding commitment with a budget of 100 million CFA francs from the International Institute for Communication and Development (IICD), the tele-radiology project is revolutionizing medical practice in Mali. Tele-radiology, or long-distance radiology in Mali, results from Doctor Mahamadou Touré’s vision. Dr. Toure is a radiologist doctor at a hospital in Point G – one of three university hospital centres in Mali where he heads a tele-radiology team.
According to Dr. Touré, of the 20 radiologists in the country only one is based in the interior, at Ségou, a city located some 220 km from the district of Bamako. "It was because of this realisation that the tele-radiology project was begun in 2005 between the hospital at Point G and three regional hospitals at Mopti, Sikasso and Ségou. Later, when a radiologist moved to Ségou, that city was replaced by Tombouctou,'' says Dr. Touré. "We are now in the middle of the test phase. If our partners continue to support us, in the next phase we will gradually be able to include all the other regional hospitals." He adds. The main objective of the tele-radiology project is the transmission to the radiology service at Point G of all x-ray photos and other radiographies requiring specialist opinion, and, in particular, to provide results within 24 hours for normal cases and within two or three hours for urgent cases. The process uses the Internet to send radiographies made in the regions for expert examination and interpretation. In Bamako, they can interpret radiographies made in the regions to assist in the diagnosis phase. As part of the project, doctors in the three participating hospitals take x-rays of their patients. The images are sent via the Internet to Bamako, the capital of Mali, where the central service specialists are located. When the images are received, specialists examine and interpret them and, depending on the urgency, send the results to the treating physician on a priority basis. Since the start of the project to March 26, 2006, Dr. Touré proudly states, "there have been 239 consultations, including 23 urgent cases." Dr. Touré gives an example, “At the start of the 2005-2006 school year. a nine-year-old schoolboy in Mopti, some 630 km into the centre of Mali, was unable to eat. The examining doctor took an x-ray but the cause of the problem was not clear. He sent the x-ray via the Internet to the team at Bamako. After consultation, I was able to tell him that there was a blockage in the esophagus. The only solution was to use fibroscopy. That means inserting a tube into the esophagus until contact is made with the foreign body and, using forceps, it is either removed or pushed down."
According to Professor Abdel Kader Traoré, Director of Mali's National Support Centre in the Fight against Sickness (CNAM), "tele-radiology will improve responses to health problems in the regions. As an indirect effect, it will also improve the health of the population and, in doing so, will contribute to development." Before the introduction of tele-radiology, doctors in the regions were faced with a dubious choice, says Professor Traoré. Either the doctor was stymied by the image and said, "we will close our eyes to that and diagnose as best we can, and the patient remains here.' Or, the patient was told, 'If you can afford it, you should go to Bamako for an x-ray that will be examined by an expert and your condition will be much clearer." "Now, thanks to tele-radiology, in either case, we are able to see a solution." Dr. Romain Rolland Tohouri, a specialist in ICT and Health, echoes that broader vision, saying, “More and more, tele-medicine or long-distance medicine is becoming a reality. It is an effective means of extending medical and diagnostic services to remote regions." Tele-radiology offers three great benefits. First, for the patient, it improves the clinical diagnosis, reduces the number of transfers to Bamako and reduces the cost of treatment. For the attending physician, tele-radiology offers greater assurance in treating a patient, reduces the feeling of isolation and, above all, opens the door to distance learning or coaching. For radiologists, tele-radiology provides access to knowledge of regional pathology. In each case, the patient pays a flat rate of 2,500 CFA francs, compared to 5,000 to 10,000 CFA francs at a private clinic. After its first year of operation, the tele-radiology team has great hopes for the future. "We hope that IICD or another partner will help us to serve the other regions,' said the project director, 'because in Mali the need for radiology is immense." Dr. Mahamadou Touré says, "We want this experience to become government practice as part of our national health policy. We have strongly urged that approach and the government health planning group is working to achieve that." There is a ray of hope on the horizon. In a pragmatic move at a meeting with the directors of the six primary regions of Mali and the district of Bamako, the national director of the Health Planning Group (CPS), Mr. Salif Samaké, invited the participants to include different aspects of ICT in their operational programmes. According to Mahamoudane Niang of REIMICOM, the Mali computer network for medical information and communication, known as Kénéya Blown, "The importance of ICT in terms of health and development will only be achieved when the greatest numbers of institutions are connected to the network."
For further information contact iConnect coordinator Filifing Diakite,
filifing@journalist.com
Wireless Broadband Africa Forums Wireless Broadband Africa Forums will be held in Nairobi and Lagos at the end of November and early December in response to the growing deployment of wireless systems across the continent. Motorolla and QUALCOMM, leading developer of CDMA technology, will be co-sponsoring the events. The East & West African Wireless Broadband Forums will provide a marketing and education platform to promote effective roll-out of the technology throughout Africa. These Forums follow the highly successful WiMAX & CDMA Forum held in Johannesburg in April 2006 (see http://new.aitecafrica.com/WiMAX_CDMA_Forum) To
propose a Forum presentation, send a brief outline to: Sean Moroney,
seanm@aitecafrica.com
· 16
October 2006, UNESCO, Paris, France · 18
October 2006, UNESCO, Paris, France · 19
October 2006, UNESCO, Paris, France · 22
October 2006, Huarun Hotel, Beijing, China
The APC Chris Nicol FOSS Prize recognizes initiatives that are making it easy for people to start using free and open source software (FOSS). The prize will be awarded to a person or group doing extraordinary work to make FOSS accessible to ordinary computer users. The APC FOSS Prize has been established to honor Chris Nicol, a long time FOSS advocate and activist who for many years worked with APC. We are looking
for initiatives that: THE PRIZE IS OPEN TO: Any person or group anywhere in the world who supports or promotes user-oriented free and open source software. The application form must be completed in either English or Spanish however there are no language restrictions regarding the language of the project. Small-scale activities are encouraged to apply. THE PRIZE:
US$ 4,000.00 may be shared by up to two initiatives at the jury's
discretion. MORE ABOUT
THE APC CHRIS NICOL FOSS PRIZE:
ICT STUDY AREAS · Contribution
of ICTCs to the development of education, science, culture and construction
of a knowledge society -The use of ICTs to promote freedom of expression PEACEFUL CONFLICT RESOLUTION STUDY AREAS (to be advised) If interested,
please contact:
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CAMEG
makes available a range of more than 500 products through telemarketing
and its website. Everyday, staff of the central agency at Ouagadougou
contact CAMEG sections around the country to determine their needs.
Edmond Traoré says that with the website, "The objective
is to give some visibility to CAMEG. The site has been in place since
2004 to provide information to everyone concerning health care at
the least cost." 
ICT
also plays a role in the health sector in overcoming distances in
terms of surgery. Recent developments in high-speed Internet connections
have made remote surgery possible. At present, such technology is
not available in Burkina Faso but this is an area where CAMEG could
make investments in, keeping up with its record as a pioneer in many
other partnership structures.
Mali
is a sprawling country with a land area of 1,204,000 km² and
a population estimated at nearly 12 million people. In medical terms,
there is an uneven distribution of human resources. 
Since
there was no fibroscope at Mopti, the child was brought to Bamako.
During the fibroscopy, the tube dislodged the obstructing matter.
It was a piece of meat. Within a few hours, the young boy was eating
normally.”