Perbedaan Linux dan Windows

BAGIAN I

Ada banyak persamaan dan ada pula banyak perbedaan antara Linux dan Windows. Mari kita lihat beberapa perbedaan yang ada di Linux dan Windows.

User Interface

Di Windows, Anda tidak banyak memiliki pilihan user interface. Sebagai misal, di Windows 95/98 Anda hanya mengenal user interface bawaan Windows 95/98. Anda sedikit lebih beruntung jika menggunakan Windows XP, karena Anda bisa berpindah dari interface milik Windows XP ke Windows 98 yang lebih ringan.

Di Linux, Anda bisa menemukan banyak macam user interface. Dan biasanya pilihan user interface ini dapat Anda sesuaikan dengan spesifikasi komputer atau lingkungan kerja Anda. Sebagai misal, pada komputer yang lambat Anda bisa menggunakan user interface yang ringan, seperti XFCE atau Fluxbox.

Atau jika Anda menyukai gaya Mac, Anda bisa memilih desktop model GNOME atau menggunakan utility Docker. Dan jika Anda terbiasa di Windows dan memiliki komputer yang cukup cepat, Anda bisa memilih desktop KDE.

Dengan KDE, Anda masih bisa memilih untuk menggunakan gaya Windows XP ataupun Windows Vista. Pilihan dan variasinya sangat banyak di Linux, Anda bisa mengatur sesuai dengan favorit Anda.

Sekuriti dan Virus

Salah satu masalah utama di Windows yang paling sering Anda temukan adalah virus dan spyware. Dari tahun ke tahun permasalahan ini bukan semakin mengecil tetapi malah semakin membesar. Ini semua terjadi karena banyak lubang keamanan di Windows yang bisa dieksploitasi oleh orang-orang yang tidak bertanggungjawab.

Linux diturunkan dari sistem operasi Unix yang memiliki tingkat sekuriti lebih kuat. Itu sebabnya tidak ada banyak virus di Linux dan kalaupun ada tidak bisa berkembang biak dengan pesat dan biasanya tidak mampu membawa kerusakan yang besar.

Sekalipun tidak sepenting di Windows, Anda tetap bisa menemukan program-program anti virus di Linux, seperti ClamAV dan F-Prot. PCLinux telah menyediakan anti virus ClamAV yang bisa ditemukan pada menu Start > Applications > FileTools > KlamAV.

Spyware

Spyware adalah suatu masalah yang cukup umum di dunia Windows. Biasanya program spyware mengamati, mengumpulkan dan mengirimkan data Anda ke suatu server. Untuk hal yang lebih positif, program ini biasanya dipergunakan untuk keperluan marketing.

Sayangnya, ada juga yang berniat buruk yaitu dengan mencuri identitas, kartu kredit, dan tindakan negatif lainnya.

Tidak banyak program spyware yang menginfeksi Linux mengingat cara kerja Linux yang lebih susah untuk ditembus. PCLinux telah menyediakan pre-instal Firewall untuk melindungi sistem Anda dan bisa diaktifkan melalui PCLinux Control Panel.

BAGIAN II

Instalasi dan Kelengkapan Program

Windows adalah sistem operasi, itu sebabnya Windows tidak menyediakan banyak program setelah diinstal. Kalaupun ada mungkin Anda hanya akan menemukan Internet Explorer, Media Player, Notepad, dan beberapa program kecil lainnya.

Ini sangat berbeda dengan Linux. Sekalipun Linux juga suatu sistem operasi, tetapi Linux disertai dengan banyak program didalamnya. Setelah diinstal, Anda akan menemui banyak program dari hampir semua kategori program. Sebut saja kategori Office Suite, Multimedia (Sound, Video, Graphics), Internet (Browser, Email, Chat, Downloader, Messenger, Torrent, News), 3D, Games, Utility, dll.

Dengan waktu instalasi yang hampir sama, Anda bukan hanya mendapatkan suatu sistem operasi tetapi juga semua program yang diperlukan untuk kegiatan sehari-hari di Linux.

Konfigurasi Sistem

Anda mungkin sering mendengar di Linux Anda perlu menyunting file secara manual melalui command line. Sebagian berita ini benar, tetapi dengan PCLINUX Control Center konfigurasi sistem bisa Anda lakukan semudah point n click. PCLINUX memiliki deteksi perangkat keras yang baik sehingga hampir semuanya berjalan secara otomatis. Dan hampir semua program di PCLINUX disertai dengan konfigurasi yang sudah siap pakai. Sebagai contoh, browser Internet telah disertai dengan sejumlah plug-ins. Tidak perlu men-download dan menginstal plug-ins flash ataupun yang lainnya.

Hardware Support

Anda sering mendengar suatu hardware tidak bekerja di Linux. Hal ini terjadi karena pembuat hardware tidak menyediakan driver versi Linux. Untungnya, belakangan ini cukup banyak vendor yang sudah memberikan dukungan driver Linux. Dan pengenalan Linux akan hardware semakin lama semakin meningkat sehingga mulai jarang terdengar permasalahan hardware di Linux.

Menangani Crash

Linux secara umum terlihat sebagai sistem operasi yang stabil. Dan jika Anda membandingkan Linux dengan Windows 95/98/ME, Linux jauh lebih stabil. Windows XP – jika Anda mengikuti petunjuk sistemnya dengan baik – akan cukup stabil.

Dan seperti halnya dengan Windows, suatu saat Anda juga akan menemui masalah di Linux. Sekalipun jarang, tetapi program yang crash atau hang bisa saja terjadi. Ini adalah suatu fakta dari kehidupan di dunia komputer.

Sekalipun demikian ada beberapa perbedaan di Windows dan Linux. Unix dan Linux mempunyai sifat multi-user. Linux menjalankan aplikasi secara berbeda dengan Windows. Ketika suatu aplikasi terkunci, Anda dapat mematikannya dengan mudah. Cukup menekan kombinasi tombol Ctrl + Esc, dan Anda dapat memilih aplikasi (atau proses) mana yang bermasalah.

Dan jika sistem grafis yang terkunci, Anda bisa berpindah ke command-prompt (dengan menekan Ctrl+Alt+F1) dan membunuh proses software secara manual. Anda juga mempunyai pilihan untuk merestart desktop saja dengan menekan Ctrl+Alt+Backspace. Ini berarti Anda tidak harus melakukan reboot sekalipun sistem Linux sedang mengalami masalah.

BAGIAN III

Partisi Harddisk

Linux tidak mengenal penamaan drive C: untuk suatu partisi. Semua drive disatukan dalam suatu sistem penyimpanan yang besar. Folder /mnt merupakan tempat untuk Anda mengakses semua media yang ada di komputer, baik partisi lain, CD-ROM, Floppy, ataupun FlashDisk.

Belakangan KDE telah memperudah akses ke media dengan menyediakan sistem Storage Media yang dapat diakses melalui My Computer ataupun file manager Konqueror.

Penamaan File

Linux menggunakan “/” untuk memisahkan folder dan bukannya “\” yang biasa digunakan DOS/Windows. Linux bersifat case-sensitive, ini berarti file “Hello.txt” berbeda dengan file “hello.txt”. Linux juga tidak terlalu memperhatikan ekstensi file. Jika Anda mengubah nama file “Hello.txt” menjadi “Hello”, Linux masih tetap mengetahui bahwa file ini adalah suatu teks. Dan ketika Anda mengklik file “Hello”, Linux secara otomatis tetap akan membuka program editor teks.

Kemudahan dan Keamanan

Anda mungkin sudah mengetahui, bahwa sebagai user biasa (bukan Root) Anda tidak bisa menulis file di sembarang folder. User biasa hanya memiliki akses tulis di folder home mereka. Sebagai user biasa, Anda tidak akan bisa mengubah bagian penting dari sistem Linux. Ini memang terkesan terlalu membatasi dan merepotkan, tetapi cara ini jauh lebih aman, karena hanya orang tertentu yang mempunyai akses Root saja yang bisa menyentuh sistem. Bahkan viruspun tidak bisa dengan mudah menyentuh sistem Linux. Itu sebabnya Anda tidak banyak mendengar adanya virus di Linux.

PENTING !!! PENTING !!! PENTING !!!

Itu sebabnya di Linux, Anda tidak disarankan menggunakan user Root untuk keperluan sehari-hari. Buatlah minimal 1 user untuk setiap komputer dan hanya pergunakan Root untuk keperluan administrasi sistem.

Hal ini berbeda jauh dengan Windows yang sangat rentan dengan virus. Ini terjadi karena user biasa di Windows juga sekaligus mempunyai hak sebagai administrator. Kebanyakan pemakai Windows tidak mengetahui hal ini, sehingga sistem mereka sangat rentan dengan serangan virus. Windows Vista sekarang telah mengadopsi sistem sekuriti Linux ini.

Defragment

Di Linux Anda tidak akan menemukan program untuk men-defrag harddisk. Anda tidak perlu melakukan defragment di harddisk Linux! Sistem file Linux yang menangani ini secara otomatis. Namun jika harddisk Anda sudah terisi sampai 99% Anda akan mendapatkan masalah kecepatan. Pastikan Anda memiliki cukup ruang supaya Linux menangani sistemnya dan Anda tidak akan pernah mendapatkan masalah deframentasi.

Sistem File

Windows mempunyai dua sistem file. FAT (dari DOS dan Windows 9x) dan NTFS (dari Windows NT/2000/XP). Anda bisa membaca dan bahkan menyimpan file di sistem FAT dan NTFS milik Windows. Hal ini tidak berlaku sebaliknya, Windows tidak akan bisa membaca atau menyimpan file di sistem Linux.

Seperti halnya Windows, Linux memiliki beberapa macam file sistem, diantaranya ReiserFS atau Ext3. Sistem ini dalam beberapa hal lebih bagus dari FAT atau NTFS milik Windows karena mengimplementasikan suatu tehnik yang disebut journaling. Jurnal ini menyimpan catatan tentang sistem file. Saat sistem Linux crash, kegiatan jurnal akan diselesaikan setelah proses reboot dan semua file di harddisk akan tetap berjalan lancar.

Style Windows Vista di Linux

Ada beberapa aspek di Windows Vista bisa Anda tampilkan di Linux, seperti gadget, aero, menu Vista, dan 3D Desktop. PCLinux menyediakan tool untuk menampilkan gadget, aero dan menu Vista. Untuk 3D Desktop, PCLinux saat ini hanya menyediakan versi demonya (untuk pengguna nVidia).

Gadget / Karamba

Konsep gadget sudah dikenal cukup lama di Linux sebagai Karamba. Gadget atau karamba adalah suatu program kecil yang dijalankan di desktop. Gadget diaktifkan melalui menu Applications > Accessories > SuperKaramba. Jika sudah aktif, SuperKaramba akan muncul di tray pada panel dalam bentuk icon bulat berwarna biru.

PCLinux menyediakan berbagai gadet, seperti Calendar, Aero Clock, Info System, Photo Slideshow. RSS SideBar dan Weather / Info Cuaca. Untuk menampilkan gadget ini di desktop, Anda cukup melakukannya dengan cara mengklik icon SuperKaramba di tray panel. Pilihlah gadget yang tersedia untuk ditampilkan di desktop.

Aero

Aero menonjolkan konsep transparansi. Secara default Anda sudah bisa menikmati konsep ini pada setiap jendela program yang muncul di layar. Anda akan melihat sisi atau border jendela yang tembus pandang dan menampilkan gambar dari background. Efek transparansi ini tetap terlihat sewaktu Anda memindahkan atau menggeser jendela program ke tempat lain. Tampilan gambar background akan mengikuti posisi dimana jendela program diletakkan.

Menu Vista

KBFX menyediakan menu ala Windows Vista. Secara default menu Vista tidak ditampilkan di PCLinux. Anda bisa mengaktifkannya dengan cara mengklik kanan area kosong pada taskbar panel dan kemudian pilihlan Add Applet to Panel. Tariklah scrollbar ke bawah dan pilih KBFX Spinx untuk mengaktifkan menu ala Windows Vista.

Maher Zain - Number One For Me | Official Music Video

Number One For Me - lyric

I was a foolish little child

Crazy things I used to do

And all the pain I put you through

Mama now I'm here for you

For all the times I made you cry

The days I told you lies

Now it's time for you to rise

For all the things you sacrificed


Chorus:

Oh, if I could turn back time rewind

If I could make it undone

I swear that I would

I would make it up to you

Mum I'm all grown up now

It's a brand new day

I'd like to put a smile on your face every day

Mum I'm all grown up now

And it's not too late

I'd like to put a smile on your face every day


And now I finally understand

Your famous line

About the day I'd face in time

'Cause now I've got a child of mine

And even though I was so bad

I've learned so much from you

Now I'm trying to do it too

Love my kid the way you do


CHORUS

You know you are the number one for me (x3)

Oh, oh, number one for me

There's no one in this world that can take your place

Oh, I'm sorry for ever taking you for granted, ooh

I will use every chance I get

To make you smile, whenever I'm around you

Now I will try to love you like you love me

Only God knows how much you mean to me



CHORUS



You know you are the number one for me (x3)



Oh, oh, number one for me



Lyrics: Maher Zain & Bilal Hajji

Melody: Maher Zain & Nano Omar

Arrangement: Maher Zain

© Awakening Records




Love this song....
check it out now Guy's...

Sakit Hati Itu Apa sih???

GUy's....

pasti kalian pernah dooong mengalami sakit hati...
buT, kalian taU ga siih apa itu Sakit Hati....???

Pertanyaan gak penting ini memang harus benar-benar dipahami meskpun ini hanya sepele. Hati adalah qolbu dalam bahasa arab atau heart dalam bahasa inggris. Penjelasan tentang hati yang sakit sebetulnya bisa cerna sendiri.

Sakit hati adalah dimana seseorang merasa sakit di dalam rongga dada dan bisa menghilangkan fungsi akal. Contoh saja orang yang sakit hati bisa bertindak apa saja karena emosi Oleh karena itu sakit hati bisa disebut juga dengan emosi atau kemarahan seseorang yang dipendam. Kebanyakan orang yang sakit hati mereka memendam rasanya untuk marah. Namun tak sedikit juga menyatakan sakit hati dengan berkata kotor.

Ada beberapa tips untuk menenangkan sakit hati :

1. Dengan berteriak sekencang di area yang tidak di didengar orang banyak

2. Dengan duduk lalu berbaring sebentar lantas mengambil air wudhu untuk sholat

3. Jika sakit hati disebabkan karena kemarahan orang lain maka tipsnya adalah nomer 2

4. Jika sakit hati adalah karena masalah asmara atau kecemburuan yang bisa menyebabkan sakit hati maka obatnya adalah cari sahabat atau teman curhat. Karena teman ngobrol bisa sedikit atasi sakit hati.

5. Biasakan mengungkapkan sakit hati dengan meminta nasehat atau curhat kepada orang yang kita percaya (bunda atau orang tua lebih baik) sedikit banyak kemungkinan orang yang kita curhati akan memberikan solusi terbaik untuk masa depan anda.

Nah jika anda sakit hati maka bisa mengunjungi klinik sakit hati.
So guy's.... Klo ada yang tau alamatnya KLinik Sakit Hati...
bOleeh deeh share disini....

Dokter Cinta

Quote from me:
Hati - Hati memilih hati
Karena Hati, yang Kurang Hati - Hati
Akan Sakit oLeh Hati, yang Kurang Hati - Hati 

Narsisme Artinya Adalah...???

GUy's.... Tau ga siih asal usul Artinya NARSIS sebenarnya...??
Penasaran...??? Check this Out...

Apakah anda adalah orang yang sering menampilkan diri Anda dengan berfoto atau mengambil video diri anda sendiri. Nah taukah anda apakah arti narsis itu sendir sebenarnya? Berasal dari bahasa inggris narisisisme (inggris) atau narisme (bahasa belanda) adalah rasa menyukai dirinya sendiri secara berlebihan. Perasaan mencintai diri sendiri adalah hal yang wajar namun bila berkelanjutan akan menjadi menimbulkan perasaan sombong akibat dari suka pamer.

Narkissos atau Narsisus jatuh cinta terhadap dirinya sendiri.
Lukisan karya Michelangelo Caravaggio.

Adalah Sigmud Freud yang menggunakan kata narsis ini pertama kali. Mengambil dari seorang tokoh di mitos Yunani yaitu, Narkissos (dalam bahasa latin : Narcissus ) terkena kututukan sehingga dia mencintai bayangan dirinya sendiri dalam kolam. Secara tidak sengaja dia menjulurkan tangannya sampai tenggelam dan menumbuhkan bunga yang indah yang hingga saat ini dijuluki bunga narsis.


Narcissus Poeticus Flower

Bawaan Sejak Lahir Sifat narsis ini adalah bawaan sejak lahir. Yang bisa ketahui tanda-tandanya dari bayi yang cuek.

Narsis Memotivasi Diri Perasaan narsis yang tidak berlebihan akan bisa menimbulkan ego yang cukup untuk membangun semangat diri. Pada tahap ini seseorang yang narsis akan tidak peduli terhadap prestasi tinggi orang lain mereka akan berkata “orang lain saja bisa kenapa kita tidak?”

Membangun Rasa Percaya Diri Sifat narsis bisa membangun rasa percaya diri ini terbukti ketika banyak orang mengagumi dirinya di cermin maka mereka akan percaya atas kemampuan dirinya sendiri tidak memandang orang lain.

Narsis Yang Berlebihan Seperti yang dikatakan di atas, sifat narsis bisa membangun ego positif dan rasa percaya diri namun narsisme yang berlebihan akan mengakibatkan seseorang egois.Meremehkan Kemampuan Orang

Jika difikirkan secara logis orang yang narsis yang terus menerus akan meremehkan orang lain , karena mereka menganggap dirinya paling hebat.

Becak Berbahan Bakar Kotoran Gajah

Kendaraan Berbahan Bakar Minyak ( BBM ) sudah banyak mendominasi jalan raya. Apalagi dengan kenaikkan BBM di bulan April 2012, memicu kenaikkan harga dimana-mana.

Kendaraan yang bertenaga Baterai pun sudah banyak diminati, dapat mengurangi polusi dan menghemat energi minyak yang semakin mahal dan terbatas.

Namun, jika anda benar-benar ingin mengurangi polusi udara, kendaraan yang satu ini perlu dicontoh. Karena kendaraan ini menggunakan bahan bakar yang terbuat dari kotoran binatang.

Dilansir Autoevolution.com, Rabu 28 Maret 2012, Kebun Binatang Denver, AS, telah membuat terobosan unik dengan membuat becak motor asal Thailand bisa melaju dengan bahan bakar yang berasal dari kotoran binatang.

Mungkin agak terdengar menjijikan, tetapi orang-orang di sana ingin membuatnya menjadi bernilai. Sebenarnya, motor itu tidak menggunakan kotoran secara mentah. Tetapi mereka merubah kotoran menjadi gas yang kemudian dirubah lagi menjadi energi listrik.

Energi listrik yang dihasilkan inilah yang menjadi tenaga untuk menjalankan si becak. Kotoran binatang yang digunakan adalah kotoran gajah. Rencananya, kebun binatang itu akan mengembangkan dan meningkatkan penggunaan teknologi ini.

Kebun binatang ini memasang target 20 persen kebutuhan energi kebun binatang akan dipenuhi dari teknologi ramah lingkungan ini. Selain menjadi terobosan yang unik, teknologi itu juga mampu mengurangi polusi udara akibat bau dari kotoran di kebun binatang.


So, guys....
Berhubung dinegara kita tercinta ini, ga banyak yang punya peliharaan gajah... hehehee...

Bagaimana kalau diganti dengan Berbahan Bakar Kotoran Sapi??

Apalagi klo sapinya segede ini...

Pasti Energinya berkali lipat...

Hyun Bin in Jakarta

GUy's.... pernah nonton "Secret Garden" kan???
so, pasti tau donk pemeran cwonya.... Who else, Hyun Bin...

Aktor Korea Selatan yang tengah menjalani wajib militer, Hyun Bin, menjadi salah satu duta negaranya untuk hadir dalam Hari Ulang Tahun TNI ke-66 di Markas Besar TNI. Bintang 'Secret Garden' itu mendapatkan pengawalan ketat.
Aktor kelahiran 1982 itu berbaris di bagian belakang, sesuai kepangkatan. Dia duduk bersama duta besar-duta besar negara asing. Usai upacara Hari Ulang Tahun TNI digelar, para tamu undangan termasuk Hyun Bin diundang untuk menikmati hidangan ramah tamah.

Hyun Bin dan dua komandannya mengikuti jamuan ramah tamah bersama Panglima TNI Laksamana Agus Suhartono dan pejabat tinggi pemerintah Indonesia. Duta Industri Pertahanan Korea untuk Indonesia dan dua komandannya itu mendapat pengawalan ketat. Tidak seperti tamu asing lain.

Tetapi, tidak ada satu pertanyaan pun yang dijawab. Termasuk pertanyaan dari wartawan Korea Selatan. Hyun Bin yang mendapat pengawalan ketat dari TNI dan Kopassus itu akhirnya menuju mobil.

Mereka menaiki mobil kedutaan besar Korea Selatan dengan nomor polisi CD 75 01. Pengawalan ketat hanya sampai Hyun Bin masuk mobil. Rencananya, pada 6 Oktober besok, bintang serial drama 'The World That They Live In' itu dijadwalkan mengunjungi Markas Komando Korps Marinir Cilandak, Jakarta Selatan.

iPhone 4S Diluncurkan 14 Oktober

berita2.com: Di kantor pusat perusahaan Apple di Cupertino, California. CEO Tim Cook meluncurkan iPhone 4S ini.  'Ini adalah pertama peluncuran produk saya sejak saya menjabat sebagai CEO. Saya yakin Anda tidak tahu itu, " guraunya.

Ini adalah peluncuran pertama sejak Cook mengambil alih posisi CEO dari Steve Jobs pendiri Apple - dan dianggap sebagai uji coba signifikan dari kepemimpinannya. iPhone baru adalah iPhone 4S, bukan iPhone 5 - tampak sangat mirip dengan model saat ini, tapi ada pengontrol suara dan fitur teknologi tinggi lainnya.  Demikian disiarkan dailymail 5 Oktober 2011.

Atas peluncuran ini, harga saham Apple anjlok 3 persen. Pasar akhirnya mengetahui bahwa Iphone yang diluncurkan adalah 4S bukan 5. Walau demikian ini adalah upgrade yang signifikan.

Handset baru akan memiliki prosesor dual core A5 seperti yang ada di iPad 2  dan kamera delapan megapixel - yang semuanya ditempatkan untuk bersaing dengan Samsung. Kamera baru ini juga dapat ‘menembak’ di HD 1080 penuh’

Fitur yang baru di 4S ini adalah fitur yang disebut Siri, memungkinkan Anda untuk 'berbicara' ke iPhone Anda seperti Anda berbicara dengan orang lain - misalnya, Anda dapat meminta ke iPhone: 'Apa perkiraan cuaca hari ini? " sambil menekan tombol Home, dan itu akan membawa anada ke sebuah ramalan cuaca.

Anda juga dapat hanya mengatakan, 'Bangunkan aku besok pada pukul 08:00, dan perangkat akan mengatur alarm untuk Anda. Anda bahkan dapat mendikte pesan Anda ke telepon. Idenya adalah bahwa Anda berbicara dengan Siri seolah-olah juga manusia.

Pada peluncurannya, Siri akan bekerja dalam bahasa Inggris,Jerman dan Perancis. Masa pakai baterai telah ditingkatkan  dan dapat digunakan sampai 8 jam untuk waktu bicaranya.

Nampaknya iPhone 4S ini disambut dengan kekecawaan dari orang-orang yang senang akan teknologi. Menurut mereka tidak ada design ulang, tidak ada versi 4G dan rasanya tidak dapat menempatkan apple sebagai pesaing jauh di depan sebagaimana yang dialami iPhone 4.  Paling tidak iPhone 4S ini dilengkapi dengan HSDPA yang lebih cepat dan jaringannya walau bukan 4G.

Mental health beyond the crises

In some parts of the world it is only during or after an emergency that people with mental health disorders get any treatment at all and often the help on offer is not what they need, Dr Mustafa Elmasri tells Fiona Fleck that the international community needs to rethink its emergency mental health relief.

Bulletin of the World Health Organization 2011;89:326–327. doi:10.2471/BLT.11.040511

Courtesy of Mustafa Elmasri

Dr Mustafa Elmasri

Dr Mustafa Elmasri is a psychiatrist in Gaza with two decades of experience working in conflicts and war, and their painful aftermath. He earned his Medical Degree from Alexandria University in 1983, Diploma in Psychotherapy from Tel Aviv University in 1996 and Diploma of Psychiatric Practice in 1997 from the universities of London and Egypt’s Ain Shams. He started his career as a doctor in Gaza in 1986 and started working in mental health care in 1992. From 1998–2000, he worked with genocide survivors in Cambodia, 2000–2003 with terrorized civilians in Algeria and 2005–2006 with Darfur refugees in Chad. Since 2008, he has been working with the World Health Organization to integrate mental health services into Gaza’s primary health care.

Q: Much of your work has been in the Middle East and northern Africa, what kind of mental health care is provided in these countries?

A: It differs from country to country, but on the whole there is a lack of psychosocial expertise. Mental health care in many of these countries is based on traditional classical psychiatry but often they have very few psychiatrists. Psychosocial work is done mainly by small local and international nongovernmental organizations (NGOs). There is practically no civil society – although that may be changing now – so much of the mental health care response in emergencies is dependent on external initiatives and funding, which are precarious. This leads to mistakes. For example, in Gaza, people came in on emergency projects after the recent war (2008–9) working directly with local people and undermining the local services. I worked with young local counsellors and saw how their work and ambitions were damaged by these short-term emergency projects.

Q: Is this typical?

A: It happens after each disaster. You have a rush of interested donors, but usually these projects and interventions are short-term and, therefore, counterproductive. Whatever emergency response is needed, it should come from within the existing health system, a structure that will exist after you leave and it should not be in the form of highly sophisticated interventions by foreigners for “poor local people”.

Q: Are the locals also unhappy about this?

A: People in need are usually happy to receive assistance, but in some cases it is not effective and quite inappropriate. For example, in former Yugoslavia in the 1990s, foreign NGO staff were chased out of villages because so many people were coming in. During the recent war in Gaza, far too many international NGOs came in. They recruited staff and trained them for a few days on some aspects of trauma work, sent them around the place going from house to house looking for traumatized people. Of course, families rejected this psychological help when what they really needed was help with basic needs, such as shelter and medical care. Young counsellors working single-handedly with no team support stood helplessly offering what was not in demand. Usually trauma and stress counsellors work in a crisis team and offer services as part of a comprehensive framework. It is not surprising that the NGOs had to bring in another wave of psychologists to work with the counsellors themselves.

Q: What is your approach?

A: I work with the local experts and structures regardless of their knowledge and expertise. The split between emergency and development projects is a business distinction that obscures the fact that every population is in a constant process of change and development. The idea of “emergency relief” is totally distorted in the psychosocial sector because it’s often only after a disaster that people get help when they needed it before. Gaza was under siege before and remains so after the war. But emergency relief was tagged to the war and has dwindled since. Six months of funding was allocated to 200 local NGOs working in the field, but none to the Ministry of Health’s mental health services.

Q: Does cultural background play a role?

A: Every mental health intervention should be adapted to the culture, today this is a given. Even if you are prescribing medication, you must take into consideration cultural beliefs on medicines. The same with psychotherapy. As trainers, we need to adapt our approach to the people we want to help. Some schools of psychotherapy are more appropriate than others. For example, cognitive behavioural therapy is usually suitable for people from Arabic-speaking cultures. It is based on evidence and rational thinking, which are part of the Arab Islamic value-system – when your beliefs are the main basis for your behaviour and when you believe that what you do will have an impact in this life and the after life.

Q: Describe your work and your life in Gaza?

A: We are integrating mental health care into the primary health care structure. The target is the wider population with mainly stress but also other common mental disorders among people who would not normally approach the mental health services. We are working with institutions to produce more mental health specialists who are badly needed in this community. We are also training nurses, psychologists and social workers. We also use other psychotherapy methods, such as cognitive behavioural therapy and other psychosocial interventions, including social work, community intervention and family psycho-education. Life here in Gaza is tough but it is a life at home with family and friends.

Q: Can you give examples of this work?

A: In Gaza, local universities produce BA level graduates of psychology, sociology and medicine with very little if any clinical experience. At present we do not have programmes for clinical psychology. Specialists are overworked and underpaid in the Ministry of Health and many are attracted by the NGO and private sectors, usually working with very narrow and pre-specified target groups within the population. But these projects do not help the many people with mild to moderate mental illness not directly related to war and trauma, and the people with severe mental illness who do not approach or receive effective mental health services. Our approach is to develop the capacity of mental health workers within the existing mental health and primary care services to provide competent and continuous help, regardless of the episodic escalations of war and violence.

Q: It’s against IASC (Inter-Agency Standing Committee) guidelines, why do we continue to see psychotherapists parachuting into emergency situations?

A: I encountered this phenomenon in Cambodia. People seemingly dropped from the sky and tried to communicate directly with the local people, to help them with their mental health problems, but it was useless. Perhaps this was because there were very few local psychologists or doctors, but I found it was better to train social workers in counselling and behavioural techniques of psychotherapy. Another example, we know now that single session debriefing is harmful, but in Gaza after the last war international NGOs sent in psychologists to debrief health and emergency staff in single-group sessions.

Q: What was your experience in Cambodia?

A: There were psychiatrists and psychologists from different parts of the world communicating through interpreters. My interpreter had to change some words because they were culturally inappropriate. International specialists should not provide direct clinical care of local people but should work with and support local care providers. Even if their local colleagues have limited experience, international specialists can train and mentor them, and give them confidence. It’s not a good idea to just drop in from the sky like a prophet, promise a lot of things and leave when the funding runs out. It means broken hearts and unfinished business – and these people have suffered enough already from loss and empty promises. They need long-term working relationships beyond the emergency situation, to help them build on the expertise you transfer.

Q: What about countries with little or no mental health experts?

A: Development is a natural phenomenon that you can assist or hinder, not something you plant or create. I worked with Darfur refugees in Chad. It is one of the poorest countries in the world and had one psychiatrist for the whole population. The challenge was to start mental health and psychosocial services from scratch. So I trained traditional healers, local nurses and medical assistants. People outside were concerned about the atrocities they had witnessed and the horrors they had experienced and there were cases of post traumatic stress disorder (PTSD) and other stress-related mental illness. But my first year involved establishing a clinical service for people with severe mental illness and children with epilepsy, some of whom had never been seen by medical personnel before. It was also essential to work with the host population as they perceived the refugees as receiving better support and care, while sharing their resources (land, wood, animals). So interventions were usually placed within the Chadian health system providing services for both camp refugees and the local population in nearby villages. The clinics became meeting places where the refugees and locals could share the pain and the cure.

Q: How did you do this?

A: Surveying traditional healing systems among refugees from Darfur in Chad, I collaborated with the faqihs (experts on Islamic law) from both the refugee and local Chadian communities, who treated medical and psychological illness. I trained them to identify epilepsy and psychosis, and refer these cases to the clinic. We also shared experiences on how we dealt with stress and mild mental illness, and learned from each other. It may sound odd or funny, but it is neither. Traditional healers were the key partner beyond the patients and their families in gaining an understanding of the psychological experience and access to social support structures. As part of our collaboration, I referred mild cases of stress and somatization disorder to the healers and they also organized group chanting and prayer groups for my patients.

Q: Are the survivors of horrific experiences scarred for life?

A: Not necessarily. Human beings are adaptable. With proper help and support many people can overcome the illness part of the trauma. Memories will remain painful, but people get on with their lives and re-build their world. In Algeria I saw how people returned to their lives, sometimes mentally more robust. We should not try to heal the historical part of trauma, it is a person’s choice whether to forgive and forget or to demand compensation. Our task is to treat the illness and help the person function normally again.

Vaccination: rattling the supply chain

The introduction of new vaccines, combined with a push to expand immunization globally to reach every child, is straining vaccine supply chains to the limit. New thinking on the way vaccines are delivered is needed. Gary Humphreys reports.

Bulletin of the World Health Organization 
2011;89:324–325. doi:10.2471/BLT.11.030511

The first decade of this century was perhaps the most productive in the history of vaccine development, seeing the release of a plethora of new life-saving vaccines for rotavirus diarrhoea, types of meningitis and pneumonia, and for human papillomavirus (HPV) infections that cause cervical cancer. “We are in a very different situation now compared to 10 years ago,” says Dr Osman Mansoor at the United Nations Children’s Fund (UNICEF) in New York. Mansoor, who is UNICEF’s senior health adviser for the Expanded Programme on Immunization and New Vaccines, notes that more vaccines are in the pipeline. In fact more than 80 vaccines are in the late stages of clinical testing, and 30 of them are designed to protect against major diseases including dengue and malaria.

At the same time, the global vaccine market is booming: since 2000, global revenue from the sale of vaccines has almost tripled reaching more than US$ 17 billion by mid-2008. While most of this expansion is accounted for by sales of new and more costly vaccines in industrialized countries, more vaccines are also reaching developing countries due to the efforts of the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization), a public–private partnership established in 2000 to increase immunization in poor countries.

WHO/Umit Kartoglu

It is important to have adequate supplies of vaccine for each vaccine session, especially when women and children, such as these in Niger, must travel long distances on foot.

The World Health Organization (WHO) and UNICEF estimate that just over 80% of the world’s children now have access to immunization, as measured by coverage of the third dose of DTP (diphtheria, tetanus and pertussis) vaccine, while an increasing number also have access to powerful new vaccines. “In the past, countries relied on a package of vaccines against six diseases,” says Project Optimize Coordinator Modibo Dicko, referring to WHO’s Expanded Programme on Immunization, which was launched in 1974. “Now some countries are doubling the number of vaccines they offer.”

As encouraging as all this seems, the scaling up of immunization programmes and the introduction of new vaccines is putting an unprecedented strain on delivery systems that have not changed in decades. James Cheyne, a supply-chain consultant, who started his career in vaccine logistics in Burma (now Myanmar) in 1977, is in a good position to judge those systems since he has had a hand in designing several himself.

Cheyne cites the unnecessary layering of distribution networks as one of his main concerns. “Typically there is a central store that supplies the regional stores, which then feed the provincial stores and district stores that in turn supply the local health centres,” he says, pointing out that while this layering made sense 30 years ago, because the lines of communication were weak, these days low-cost telecommunications technology has changed things. “You don’t need a store for each administrative level anymore because we have cell phones and the person from the health centre can call the central store directly,” Cheyne says.

Making better use of that kind of technology is a core aspect of the work being done by Project Optimize, a collaboration between WHO and PATH (formerly the Program for Appropriate Technology in Health), a nongovernmental organization.

For Michel Zaffran, the director of Project Optimize, information technology is key in combating one of the biggest problems faced by vaccine distribution systems – overstock in supply. On the face of it the idea that immunization programmes are hampered by too much vaccine seems paradoxical. But, in fact, the overstocking of vaccines increases cold storage costs and generates waste (when vaccines are lost, damaged or not used before their expiry date, and when not all vials in a multi-dose vial get used).

“We want to have as little buffer stock as possible, but still we want to have enough vaccine to vaccinate the children,” Zaffran says, arguing that this means putting in place information systems and technologies that give managers a real-time picture of how much stock they have throughout a country and whether the quantities meet the requirements of their immunization strategy.

WHO/Umit Kartoglu

Health worker in Niger shows bottles with vaccine vial monitors.

According to UNICEF’s Mansoor, an even more pressing problem is when there are shortages of vaccine supplies to meet demand for children who turn up for vaccination sessions.

These problems can be further exacerbated when the volume of vaccine flowing through the system increases, as has been the case since 2000, and vaccines have become bulkier, partly due to manufacturers’ packaging policies. As Zaffran explains, increased price is one of the main drivers of this trend: “In the early days when the vaccine cost around US$ 0.10, WHO encouraged health workers to open a vial for one child even if it meant wasting nine doses. There were wastage rates of 60% or 70%. Now that we are introducing vaccines, which cost several dollars a dose, things have changed.”

According to Dicko, the cost of newer vaccines is between US$ 3.50 and US$ 7.50 per dose (when procured through UNICEF) and sometimes more. Newer vaccines are often in single or two-dose packages. While this helps to reduce wastage, it also means that they require more cold chain space per dose compared with the traditional EPI (Expanded Programme on Immunization) vaccines that come in 10- and 20-dose vials.

Another significant driver of increased bulk is more sophisticated packaging. Until 2009, the only pneumococcal conjugate vaccine (against a range of child infections including pneumonia and meningitis) was only available in a pre-filled syringe that required nearly 20 times as much storage space as in a 10-dose vial. “New vaccines require upwards of five times the amount of physical space in cold storage,” says Dicko, who cites the problems faced by Turkey as an example of the sort of challenges that result. “In 2005 Turkey needed only 2600 m² of cold storage in order to accommodate its stocks of vaccine. When they introduced the first generation of pneumococcal vaccine in 2008, Turkey’s storage space requirement jumped (four times) to 11 400 m². They had to rent cold storage space.” Turkey found a solution, but not every country does. For Zaffran it is not too strong to describe the situation faced by many countries as a “crisis”. “Countries are postponing the introduction of these vaccines because they do not have the capacity,” he says. “Some countries are actually delaying the time when the vaccines arrive, even when they have been paid for by others because they do not have the capacity either at the central level or in the country.”

The kind of problem faced by Turkey is also causing people to rethink the use of the cold chain, the temperature controlled supply chain, which has traditionally been used for virtually all vaccine delivery. “Most vaccines are stored at a temperature of between 2 and 8 degrees Celsius,” explains Cheyne, referring to guidance that is described on the vaccine packaging.

“One vaccine has the potential of being kept for six months at 45 degrees, but the requirement is still to keep it at temperatures between 2 and 8. It makes absolutely no sense at all,” he says. Moving some vaccines from the cold chain to a temperature-controlled chain at, say, 25 degrees, would make room for other vaccines or enable countries to cut back on storage costs Cheyne argues. UNICEF’s Mansoor sees another advantage. “For me, the issue is not so much getting vaccines out of the cold chain but getting them beyond the cold chain to reach into areas where there is no refrigeration so that more children can benefit,” he says.

WHO/Umit Kartoglu

Vaccine supplies packed in cold boxes and strapped to a motorbike for delivery in a rural area in Niger.

For Mansoor the move makes even more sense given the availability of vaccine vial monitors (VVM), which are now on the label of virtually all vaccines shipped by UNICEF. The labels carry the image of a circle containing a white square. “The white square gets darker with cumulative heat exposure. If the vaccine has been subjected to heat that risks making it subpotent, the VVM shows this when the colour of the inner square is the same or darker than the outer circle,” Mansoor explains. Currently there is no equivalent detection method for freezing, which is much more damaging to some of the newer vaccines than heat in current cold chain arrangements. Like Cheyne, Dicko thinks there are many candidates for removal from the cold chain, citing as examples the vaccines against hepatitis B, Japanese encephalitis, cholera, diphtheria, tetanus and HPV infections. However, he says, this list cannot be drawn up without the consent of the manufacturers and the regulatory authorities. “It cannot be done outside that process,” he says, “but we are building evidence that it can and should be done”.