Author: Théophile Niyitegeka

Working together towards eradication of clubfoot as permanent disability in Rwanda

{ {{Clubfoot background and in the society }}

Clubfoot or congenital talipes equinovarus (CTEV) is a common congenital musculoskeletal defect that is characterized by a downward and inward twisting of the foot. Around the world, 150 000 – 200 000 babies with clubfoot are born each year.

Approximately 80% of these will be in low and middle income countries. Most of these babies will not receive effective treatment for their clubfoot and will grow up with severe disability as a consequence. }

The burden of this disability impacts on society as a whole and as such the problem of untreated clubfoot should be viewed as a public health issue which must be addressed. The UN Convention on the Rights of Persons with Disabilities Article 26 states that persons with disabilities should have access to rehabilitation services which enable them to attain and maintain maximum independence and ability.
(http://www.ohchr.org/EN/HRBodies/CRPD/Pages/ConventionRightsPersonsWithDisabilities.aspx#26)
These services should begin at the earliest possible stage and should be provided by appropriately trained rehabilitation professionals.

Untreated or incorrectly treated clubfoot soon becomes ‘neglected clubfoot’ as the child grows older and learns to walk. As the child bears weight through it, the foot position worsens and becomes more twisted. The child’s weight goes through the side and top surface of the foot as it twists, and a large bursa and callous form on the weight-bearing surface. A child with neglected clubfoot will have difficulty in wearing normal shoes and as they grow older may experience severe pain. Neglected clubfoot severely restricts ability to walk in some cases, and in others only short distances are manageable.

In Rwanda like in other Low and Middle Income Countries LMICs where transport and other infrastructure are not developed and people’s main source of income tends to be agricultural or manual labour the consequences of a neglected clubfoot can be devastating, severely impairing the individual’s ability to participate in society and income-generating activities.

In many places people with visible deformities are stigmatised and excluded from society because of cultural beliefs about disability. Practically, this can mean that individuals with clubfoot may be less likely to attend school, marry or get a job. Even the families of children with clubfoot may experience prejudice as people in some cultures believe that clubfoot is caused by a curse or evil spirits. In some countries, the mothers of children born with clubfoot may be blamed for the deformity, leading to severe family conflict, separation and even divorce. This further perpetuates the cycle of lack of participation, poverty and vulnerability caused by disability.

{{Profile of cure international/Rwanda clubfoot program }}

Cure international is an INGO established in the United States of America in 1998, based in Harrisburg, Pennsylvania. Since 1998, CURE has championed the cause of children with correctable disabilities through the development and operation of a network of hospitals and paediatric specialty programs in 26 nations. Over the course of that time, CURE has provided healing during the course of more than 1.6 million outpatient visits and over 122,000 surgical procedures, presenting our staff with the opportunity to train more than 5,200 national medical practitioners in first world quality, compassionate patient care. Its mission, taken from Luke 9:2, is to “heal the sick and proclaim the kingdom of God.” CURE Clubfoot is one of the speciality programs of CURE International.

{{Rwanda clubfoot program}}

The program started by working in 2009 with 8 hospitals and in 2011 the number of hospitals was increased to the current number of 22 government and private health facilities.

{{The program covers all the provinces of the country:}}

Northern province: Ruhengeri, Nemba and Byumba Hospitals

Southern province: Kabgayi, Munini, Nyanza, CHUB, Kigeme hospitals & Gikonko HC

Eastern province: Gahini, Nyagatare, Nyamata and Kirehe hospitals

Western province: Gisenyi, Kibuye, Gihundwe, & Kibogora hospitals and Rilima center.

City of Kigali: Muhima, Masaka, Kibagabaga and Gikondo-Inkurunziza Orthopedic hospitals

For the above health facilities, Cure International have to ensure that the program is funded in a manner consistent with guidelines and known best practices in:

Ponseti method of clubfoot management

Capacity building (trained staff)

Coordination, monitoring and evaluation of the program

Implementing the program in cost-effective way

Community sensitization

Counseling of parents

{{Vision in 3 years with Ministry of Health (MOH)}}

Both parties Cure International and MOH strive for early treatment to be accessible for every child born with clubfoot in the country, such that clubfoot will be eliminated as a permanent disability

{{Rwanda Clubfoot program goals }}

To assist the Rwandan Ministry of Health in strengthening the Rwandan health system by supporting the mentioned health facilities in their respective rehabilitation services.

To increase the knowledge of physiotherapists, Medical doctors and orthopaedic staff in the above mentioned hospitals through the trainings about management of clubfoot deformity by Ponseti technique with other supporting stakeholders

To raise public awareness on early childhood clubfoot screening program for detection, diagnosis and treatment where clubfoot centers are located in the country through all channel of media.

Provide Counselors who will work with parents to ensure clinic visits and prevent dropouts.

Support parents from poor families to access on the treatment

Parents accompaniment and advice to accomplish the treatment timeline

{{Some of achievements}}

Since 2009, more than 4700 children with clubfoot have been treated in the above hospitals using Ponseti technique,279 Health professionals have been trained about clubfoot treatment using Ponseti technique and 37 counsellors have been trained for parent’s education.

Image 6: Parent education by the trained counselor

{{Activities}}

Treating children with clubfoot using Ponseti technics ( Providing treatment supplies, treatment fees)

Organize a regional training of trainers (TTT) on club foot management using ponseti method

Train health care professionals in club foot management using ponseti method
Train counselors

Produce and distribute video CDs to the 22Hospitals and 264 health centres

Broadcast clubfoot program activities via public radios

Organize a World clubfoot day event

Educate health professional of health centres on early detection and referral of clubfoot cases

Integrate Community Health workers (CHWs) in charge of maternal and child health in community outreach activities

Supervise Hospitals

Data collection , analysis and reporting

Organise patients follow up through homes visits

{{Partners }}

Ministry of Health /RBC

National Council of Persons with Disabilities (NCPD)

National Commission of Children (NCC)

22 hospitals

COSECSA Oxford Orthopedic Link & Africa clubfoot Training Project

Rwanda Broadcasting Agency (RBA)

Churches

Private pharmacies

{{Ways of awareness}}

Posters

Radio spot

Stakeholders meetings/Symposium

Online newspaper/media

Patient stories

Brochures

Integration of Community health Worker (CHWs), Local leaders and pastors

Distribution of clubfoot DVDs in hospitals and health centers

{{Treatment cost of 1 case of clubfoot}}

In many LMICs, the price of treatment combined with the cost of transportation and the time away from income-generating activities is often more than most families can afford.

From the research conducted by Hussein et al in LMIC (Pakistan) published in 2014, the average per-patient cost was $349 (Rwf 288,972) for the Ponseti method and $810 (Rwf 670,680) for patients treated surgically. The direct household expenditure was $154(Rwf 127,512) and $314 (Rwf 259,992) for the Ponseti and surgical methods, respectively. The majority of the costs were incurred pre-diagnosis and after inadequate treatment, with the largest proportion spent on transportation, material, and fee for service. [https://www.ncbi.nlm.nih.gov/pubmed/24711155 visited on Dec 3rd 2017]

{{Plan for non cure clinics in the future}}

In collaboration with Centre de Chirurgie Orthopédique Pédiatrique et Réhabilitation, Sainte Marie de Rilima, Cure International trains the health Professionals from Clinics which are directly supported by Cure International. This will continue.

We are planning to open new clubfoot clinic in partnership with HVP Gatagara in Nyanza district since July 2017

{{Challenges}}

Low level of awareness in the community

Turnover of health professionals

Lack of clubfoot oriented researches to generate evidence based and disaggregated data on clubfoot in Rwanda

Long duration of treatment (up to 5 years) that may cause drop outs

Referral issues of complicated cases to specialized Clinics which are not using Mituelle de sante

Coverage of transport for patients for the frequent visits

{{Contribution of MOH in achievement }}

The collaboration between MOH and Cure International is well established to provide policies and strategies guidance, to facilitate Cure International to import work related materials,

Cooperate and assist Cure International for Licenses acquisition.

January 30, 2017
Rwanda Peacekeepers in South Sudan provide healthcare and school kits to locals

{On 28 January 2017, Rwanda Peacekeepers serving under United Nations Mission in South Sudan (Rwanbatt-1) together with the local population of Kapuri Basic School, the school leadership, teaching staff and students organized a community work to clean the school environment and provide health care to local population in Luri County, Jubek State.}

The humanitarian activities conducted during the community work include; providing free medical service by de-worming 121 people, medical consultation, donating Vitamin A and clean water.

The Peacekeepers also cleaned the classrooms, administrative blocks and School surroundings. They built a volleyball playground and donated school kits to Kapuri Basic Students that include 3000 Exercise books, 1200 pens, Volley Ball net and poles and two balls for Volley Ball.

Speaking at the Event, the Contingent Commander (Rwanbatt-1), Lt Col John Ndengeyinka thanked the local community members for having turned up, and most importantly the school and local leadership for having been cooperative in the planning of the community work. He emphasised on the obligation of the local community in respect of the security and School facilities as it mainly belongs to them and called upon the population “take fully ownership of this school in your hands”, he advised Kapuri residents who turned in a big number to the community work conducted ahead of the academic year starting on 1st February 2017.

Local Leader, Sultan Saverio WANNI, on behalf of the local population thanked UNMISS especially Rwandan contingent for their role of improving the learning environment of Kapuri School. 2. Kapuri Basic School was constructed by the UNMISS Rwandan Contingent in 2014 and inaugurated in early 2015.The school is located at 16 km west of UNMISS Tomping base camp in Luri County, Jubek State in South Sudan.

January 30, 2017
Living without lungs for six day saves a mom’s life

{In a bold and very challenging move, thoracic surgeons at Toronto General Hospital, University Health Network removed severely infected lungs from a dying mom, keeping her alive without lungs for six days, so that she could recover enough to receive a life-saving lung transplant.}

This is believed to be the first such procedure in the world, made possible by advanced life support technology, a dedicated and diverse surgical, respirology, intensive care and perfusion team, as well as the grit and gumption of the patient and her close-knit family.

“This was bold and very challenging, but Melissa was dying before our eyes,” recalls Dr. Shaf Keshavjee, Surgeon-in-Chief, Sprott Department of Surgery at University Health Network (UHN), one of three thoracic surgeons who operated together on Melissa to remove both her lungs. “We had to make a decision because Melissa was going to die that night. Melissa gave us the courage to go ahead.”

Melissa Benoit, then 32, was brought into Toronto General Hospital’s (TGH) Medical Surgical Intensive Care Unit (MSICU) in early April 2016, sedated and on a ventilator to help her laboured breathing. For the past three years, Melissa, who has cystic fibrosis, had been prescribed antibiotics to fight off increasingly frequent chest infections.

A recent bout of influenza just before her hospital admission had left Melissa gasping for air, with coughing fits so harsh that she fractured her ribs. Her inflamed lungs began to fill with blood, pus and mucous, decreasing the amount of air entering her lungs, similar to a person drowning.

As Dr. Niall Ferguson, Head of Critical Care Medicine at the University Health Network (UHN) and Mount Sinai, describes it, the influenza “tipped her over the edge into respiratory failure. She got into a spiral from which her lungs were not going to recover. Her only hope of recovery was a lung transplant.”

Melissa’s oxygen levels dipped so low, conventional ventilation was no longer enough. To help her breathe, and to gain more time until donor lungs became available, physicians placed her on Extra-Corporeal Lung Support (ECLS), a temporary life-support medical device that supports the work of the lungs and heart. Despite this, Melissa’s condition worsened.

The bacteria in her lungs developed resistance to most antibiotics, and spread throughout her body. Her blood pressure dropped. She slid into septic shock, triggering inflammation, leaky blood vessels and reduced blood flow. One by one, her organs began to shut down. She had to have kidney dialysis.

Melissa was now on maximum doses of three medications to maintain her blood pressure, along with the most advanced respiratory support, and on last-line powerful antibiotics, the last option for patients resistant to other available antibiotics. The team was still waiting for donor lungs but, by this time, Melissa was too sick to have a lung transplant.

Dr. Marcelo Cypel, the thoracic surgeon on call that late April weekend, kept a careful watch on Melissa. On a Sunday afternoon, with the clock ticking, he kept weighing her risk of death versus the risk of trying something which had never been done before.

It was bold, but scientifically sound. Removing both her lungs — the source of bacterial infection — could save her life.

Dr. Cypel gathered his colleagues, calling in Dr. Shaf Keshavjee, Dr. Tom Waddell, Head of Thoracic Surgery at UHN, Dr. Niall Ferguson, and respirologist Dr. Mathew Binnie — all seasoned and well-known for their skills in navigating complex cases, along with Melissa’s husband, mom and dad.

The surgical team had been discussing the concept of this procedure for several years. They had observed patients with cystic fibrosis, waiting for a lung transplant, who developed severe lung infections. These infections spread through the bloodstream into their bodies, resulting in septic shock and death, despite maximum support on the ECLS device.

While the team faced many unknowns — risk of bleeding into an empty chest cavity, whether her blood pressure and oxygen levels could be supported afterwards, and if she would even survive the operation — they agreed that Melissa was a possible candidate, and that it was her only chance, although a slim one.

As Dr. Keshavjee explained, she likely still had enough strength to withstand the procedure and get better afterwards, the source of the infection was clear-cut and difficult to control in current circumstances, the family understood the risks and explained that Melissa had often told them she would want to try everything possible to live for her husband Christopher and two-year-old daughter, Olivia.

“Things were so bad for so long, we needed something to go right,” remembers, Chris, “and this new procedure was the first piece of good news in a long time. We needed this chance.”

As Melissa tells it, Chris was the one who “held my life in his hands…He had to trust in himself, knowing me, relying on past conversations, and he chose exactly what I would have told him to.”

Melissa’s mom, Sue, was so eager to save her daughter’s life, she urged the team to go ahead: “Melissa always volunteers for any study or clinical trial. She would want to do this. Let’s not waste any more time and get her into the OR.”

At 9:00 pm that Sunday evening in mid-April, a team of 13 operating room staff, including three thoracic surgeons — Drs. Cypel, Keshavjee and Waddell — removed Melissa’s lungs, one at a time, in a nine-hour procedure. Her lungs had become so engorged with mucous and pus that they were as hard as footballs, recalls Dr. Keshavjee. “Technically, it was difficult to get them out of her chest.”

But within hours of removing her lungs, Melissa improved dramatically. She did not need blood pressure medication, and most of her organs began to improve.

To keep Melissa alive, she was placed on the most sophisticated support possible for her heart and lungs. Two external life support circuits were connected to her heart via tubes placed through her chest.

A Novalung device, a small portable artificial lung, was connected by arteries and veins to her heart to function as the missing lungs. Working with the pumping heart, the device added oxygen to her blood, removed carbon dioxide, while helping to maintain continuous blood flow. At the same time, another external device, extracorporeal membrane oxygenation (ECMO), which has an external pump, circuit and oxygenator for the gas exchange of oxygen and carbon dioxide, also helped to circulate oxygen-rich blood throughout her body.

TGH is a leader in using these technologies, with the largest such program in Canada, performing up to 100 ECLS cases per year. ECLS specialists or perfusionists and MSICU nurses are specially trained in caring for patients on various ECLS devices. Six days later, a pair of donor lungs became available and Melissa was stable enough to receive a lung transplant in late April 2016.

“The transplant procedure was not complicated because half of it was done already,” noted Dr. Cypel, “Her new lungs functioned beautifully and inflated easily. Perfect.” For the past several months, Melissa has been steadily improving. Her previously thick hair is growing back, she can play with her daughter for whole days without getting tired, and she has not needed a walker or cane for the past month. She is still on kidney dialysis.

“It’s the simple things I missed the most,” she said, “I want to be there for Chris and Olivia, even through her temper tantrums! I want to hear Olivia’s voice, play with her and read her stories.”

The medical team is developing criteria for the select types of patients who could be candidates for this novel procedure while waiting for a lung transplantation. The report of this case by Drs. Marcelo Cypel, Shaf Keshavjee, Tom Waddell, Lianne Singer, Lorenzo del Sorbo, Eddy Fan, Mathew Binnie and Niall Ferguson on Melissa Benoit entitled, “Bilateral pneumonectomy to treat uncontrolled sepsis in a patient awaiting lung transplantation” is published online in The Journal of Thoracic Cardiovascular Surgery, November, 2016.

January 30, 2017
Ngoma: Four arrested for distilling illicit gin

{Four men are in police custody in Ngoma District in connection with distilling the illicit gin commonly known as kanyanga.}

They were arrested on January 28 in separate police operations conducted in the sectors of Remera and Murama.

This was after residents in the area tipped-off the police, Inspector of Police (IP) Emmanuel Kayigi, police spokesperson for the Eastern region, said.

He identified the suspects as Felicien Mvukiyehe, Vedaste Samvura, Emmanuel Hakizimana and Sylvestre Vatiri.

“Hakizimana and Sylvestre were arrested red-handed in Murama after an area resident, who saw them distilling the illicit crude gin,” said IP Kayigi.

The duo had already distilled 35 litres of crude gin, which they were caught with.

Fighting drug related crimes is among the priorities of Rwanda National Police (RNP).

“The best part in the fight against trafficking, sell and use of drugs is that the people have owned it themselves, and this has led to arrest of many people involved and seizure of the drugs,” he noted.

Elsewhere, police operations on January 28 in Gicumbi and Burera districts seized contrabands that include 74 litres of kanyanga, 90 sachets of African Gin and 30 bottles of chief waragi, among others.

January 30, 2017
Pets are a child’s best friend, not their siblings

{Children get more satisfaction from relationships with their pets than with their brothers or sisters, according to new research from the University of Cambridge. Children also appear to get on even better with their animal companions than with siblings.}

The research adds to increasing evidence that household pets may have a major influence on child development, and could have a positive impact on children’s social skills and emotional well-being.

Pets are almost as common as siblings in western households, although there are relatively few studies on the importance of child-pet relationships.

”Anyone who has loved a childhood pet knows that we turn to them for companionship and disclosure, just like relationships between people,” says Matt Cassells, a Gates Cambridge Scholar at the Department of Psychiatry, who led the study. “We wanted to know how strong these relationships are with pets relative to other close family ties. Ultimately this may enable us to understand how animals contribute to healthy child development”

This study, published in the Journal of Applied Developmental Psychology, was conducted in collaboration with the WALTHAM Centre for Pet Nutrition, part of Mars Petcare and co-funded by the Economic and Social Research Council as part of a larger study, led by Prof Claire Hughes at the University of Cambridge Centre for Family Research. Researchers surveyed 12 year old children from 77 families with one or more pets of any type and more than one child at home. Children reported strong relationships with their pets relative to their siblings, with lower levels of conflict and greater satisfaction in owners of dogs than other kinds of pets.

”Even though pets may not fully understand or respond verbally, the level of disclosure to pets was no less than to siblings,” says Cassels. “The fact that pets cannot understand or talk back may even be a benefit as it means they are completely non-judgmental.

“While previous research has often found that boys report stronger relationships with their pets than girls do, we actually found the opposite. While boys and girls were equally satisfied with their pets, girls reported more disclosure, companionship, and conflict with their pet than did boys, perhaps indicating that girls may interact with their pets in more nuanced ways.”

“Evidence continues to grow showing that pets have positive benefits on human health and community cohesion,” says Dr Nancy Gee, Human-Animal Interaction Research Manager at WALTHAM and a co-author of the study. “The social support that adolescents receive from pets may well support psychological well-being later in life but there is still more to learn about the long term impact of pets on children’s development.”

January 30, 2017
Musanze: DASSO personnel urged on integrity

{The coordinator of District Administrative Security Support Organ – DASSO – Chief Supt. Sam Rumazi has called for good work ethics and integrity for all members of the organization.}

Chief Supt. Rumanzi was speaking to DASSO members in Musanze District in a meeting held on January 27 in Muhoza Sector.

The meeting had been convened to review their working operations and to devise plans of improving their security support services to local administration and communities.

While lauding them for the good in ensuring safety and security, he hasten to add that occasionally, some members are act unprofessionally with indiscipline.

“I know most of you work with fairy good conduct but there are some bad characters that need to be checked,” the coordinator said

He further said that to earn the confidence of the public, they needed to be act with discipline, avoid irresponsible alcoholism and be transparent while serving the people.

He further noted that maintaining security should largely involve preventing the occurrence of crime by sharing among themselves and other security organs, potential threats for quick responses.

January 30, 2017
These two things truly define who you are

{As complex as man might seem, there are two things that truly define a person — your patience when you have nothing, and your attitude when you have everything.}

A lot could be said about you when you have nothing; your patience to wait for what you desire, the energy you put in to work for your desired goal, and the way you go about what you want. This period of a person’s life when there’s nothing could tell a lot about that person; attitude, choices made, humility and work.

Then, a lot could also be said about you when you have everything. How much have you changed? How humble or proud are you now? What characters do you now exhibit? How do you relate with people? How much appreciation do you show? How much do you work for things?

When a man has nothing, and when he has everything puts him at two different ends of his life, and a lot could be said about him at these two points of his life.

Whenever you are at these two points in your life, always look inward and check the characters you are exhibiting.

January 30, 2017
Huye: Cyclists sensitised on crime prevention

{The District Police Commander of Huye, Supt Jean Marie Vianney Karegeya urged cyclists to work hand in hand with security organs in identifying suspected wrongdoers and keeping communities free from criminals.}

The DPC made the call on January 28 while speaking to over 300 commercial cyclists, shortly after a monthly community work – Umuganda.

He asked them to shun all acts criminality such as selling and abusing drugs.

He also advised them that excessive drinking can as well ruin their lives.

Supt. Karegeya reminded the cyclists to always value their lives by respecting road traffic regulations to prevent accidents and loss of lives.

He also appealed to them to work professionally while wearing reflector jackets, install headlights to help them when operating at night.

The DPC remarked that cyclists are among the major cause of road accidents especially in towns due to bad maneuvers.

“Ensuring safety and security, and safer roads is your duty as well; report anything unlawful, which is what community policing requires of you.”

January 30, 2017
World leaders condemn Donald Trump’s ‘Muslim ban’

{Politicians, rights groups and activists criticise Trump’s crackdown on refugees from Muslim-majority countries.}

European leaders, the United Nations and international groups have condemned US President Donald Trump’s measures against refugees and travellers from several Muslim-majority countries.

The chorus of criticism came as passport holders from Arab countries were blocked on Saturday from passing through customs at US airports and others were prevented from boarding US-bound planes.

Trump on Friday signed an executive order that will curb immigration and the entry of refugees from some Muslim-majority countries. He separately said he wanted the US to give priority to Syrian Christians fleeing the civil war there.

The bans, though temporary, took effect immediately, causing havoc and confusion for would-be travelers with passports from Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen.

The United Nations refugee agency and the International Organization for Migration called on the Trump administration to continue offering asylum to people fleeing war and persecution, saying its resettlement programme was vital.

“The needs of refugees and migrants worldwide have never been greater and the US resettlement programme is one of the most important in the world,” the two Geneva-based agencies said in a joint statement on Saturday.

{{‘Part of our duties’}}

Germany and France also expressed discontent with Trump’s measures.

“The reception of refugees fleeing the war, fleeing oppression, is part of our duties,” Jean-Marc Ayrault , France’s foreign minister, said during a joint news conference with his German counterpart, Sigmar Gabriel .

Germany has taken in more than one million refugees and migrants, mainly from the Middle East, since 2015.

Although traditionally open to asylum seekers, France has taken in far fewer refugees than Germany since the migrant crisis erupted.

Some in the French government, mostly ex-premier Manuel Valls, have criticised Berlin’s open-door policy, as has Trump.

“The United States is a country where Christian traditions have an important meaning. Loving your neighbour is a major Christian value, and that includes helping people,” said Germany’s Gabriel.

“I think that is what unites us in the West, and I think that is what we want to make clear to the Americans.”

Turkish Prime Minister Binali Yildirim also said the Republican’s sweeping ban on people seeking refuge in the US is no solution to problems.

“Regional issues cannot be solved by closing the doors on people,” Yildirim said during a joint news conference in Ankara with Britain’s Prime Minister Theresa May, adding that Western countries should do more to help ease Turkey’s refugee burden.

May, however, refused to condemn Trump’s refugee suspension.

“The United States is responsible for the United States’ policy on refugees.” she said when repeatedly pressed on the issue.

But other European leaders made their concerns clear, with Luxembourg Foreign Minister Jean Asselborn condemning the new measures.

“The decision is .. bad for Europe, because it’s going to strengthen even further the mistrust and hatred towards the West in the heart of the Muslim world,” he told the Sunday edition of German daily Tagesspiegel, excerpts of which were released a day in advance.

{{‘Extreme xenophobia’}}

Inside the US, Democrats were also quick to condemn Trump’s order, saying it would tarnish the reputation of the country.

“Today’s executive order from President Trump is more about extreme xenophobia than extreme vetting,” said Democratic Senator Edward Markey in a statement.

Chuck Schumer , the New York senator, also criticised Trump’s move, saying in a tweet:

Yet some Republicans praised Trump’s move. Bob Goodlatte, chairman of the House of Representatives Judiciary Committee, said the US president “is using the tools granted to him by Congress and the power granted by the Constitution to help keep America safe and ensure we know who is entering the United States”.

“What we have to remember in all of this is that there are millions of Americans who like what Trump is doing when he’s revamping immigration and the visiting to the US,” Al Jazeera’s Kimberly Halkett, reporting from Washington, DC, said.

“It’s what he promised to do during the campaign trail and in his inauguration speech.”

{{‘Not time for walls’}}

Trump on Wednesday also ordered the construction of a US -Mexican border wall , a major promise during his election campaign, as part of a package of measures to curb undocumented immigration.

Ostensibly referring to Trump’s executive order, Iranian President Hassan Rouhani said in a speech on Saturday: “Today is not the time to erect walls between nations. They have forgotten that the Berlin wall fell years ago.”

He added: “Today is the time for peaceful co-existence, not the time to create distance among nations.”

But Milos Zeman , the president of the Czech Republic, praised the decision. Writing on Twitter, Zeman’s spokesperson said Trump “protects his country” and called for the European Union to take similar measures.

Dutch politician Geert Wilders , known for promoting Islamophobia, tweeted: “Well done @POTUS it’s the only way to stay safe + free. I would do the same. Hope you’ll add more Islamic countries like Saudi Arabia soon,” using an acronym for President of the United States.

January 29, 2017
Protest at JFK airport over Trump’s refugee ban

{Protests planned at several more US airports as authorities block entry of migrants, including green card holders.}

Protests have broken out at the John F Kennedy (JFK) International Airport in New York City as immigrants, including US green card holders, are detained following right-wing President Donald Trump’s executive order placing harsh restrictions on travellers from several Muslim-majority countries.

Hundreds of demonstrators chanted “No ban, no wall, sanctuary for all!” and “no hate, no fear, immigrants are welcome here!” while gathering outside the airport’s Terminal Four arrivals section.

Other protests were held at airports in Chicago, San Francisco, Washington, DC, among other US cities.

The protests came in response to passport holders from Arab countries being blocked on Saturday from passing through customs at US airports, while others were prevented from boarding US-bound planes.

On Friday, Trump signed an executive order to curb immigration and the entry of people from some Muslim-majority countries. He separately said he wanted the US to give priority to Syrian Christians fleeing the civil war there.

Trump placed a four-month hold on allowing refugees into the country and temporarily barred travellers from Syria and six other Muslim-majority countries.

The protest was attended by several New York-based organisations, including Make the Road New York, Jews for Racial and Economic Justice (JFREJ), Black Latino Asian Caucus members and The New York Immigration Coalition, among others.

Speaking to Al Jazeera, Julia Carmel, an organiser with JFREJ, decried Trump’s executive order.

“The purpose of our protest at JFK airport is two-fold. First, we are demanding the safe release of refugees and other visa-holders, all of whom cooperated with a long and gruelling vetting process in order to get here,” she said.

“Additionally, the central message of our protest is that we are all immigrants or children of immigrants and refugees. The executive order is not only inhumane; it is absurd and hypocritical,” she added, pointing out that the ban came into effect on Holocaust Remembrance Day (Friday).

Tara Raghuveer, a 24-year-old national immigrant rights organiser with Make the Road New York, described the executive orders as “deeply un-American”.

“They go against everything our country aspires to stand for,” she told Al Jazeera at the protest.

Kazi Fouzia, a 48-year-old Bangladeshi immigrant and activist with Desis Rising Up and Moving, said she came to the protest to say: “Banning one of us is banning all of us. Terrorising one of us is terrorising all of us.”

Fouzia, who has lived in New York City for ten years, added: “We are here to make sure every single held in JFK will be released… we have to take down the policy.”

Lawsuits

Trump administration officials have defended the executive order. Speaking to reporters on Saturday, a senior US administration official confirmed that the restrictions will impact legal permanent residents, known as green card holders, on a case-by-base basis.

For at least 90 days, citizens of Iraq, Iran, Somalia, Yemen, Sudan and Libya are barred from entering the country. Syrians have been banned from entering the US indefinitely.

Immigrants from the seven countries have been blocked from bordering US-bound planes in Lebanon, Egypt, United Arab Emirates and elsewhere.

Legal representatives for two Iraqi men filed lawsuits against Trump and the US government on Saturday, according to the American Civil Liberties Union (ACLU), a rights group.

Both men had ties to the US military and were had visas. They were detained on Friday night in JFK Airport.

“President Trump’s war on equality is already taking a terrible human toll. This ban cannot be allowed to continue,” said Omar Jadwat, director of the ACLU’s Immigrants’ Rights Project, in a statement .

January 29, 2017