Here’s what we’re reading today:
Trachoma casts shadow over Aboriginal communities, Australian Broadcast Corporation
Chagas disease surveillance focuses on palms, undercover bugs, Beth King, Smithsonian Tropical Research Institute
ADRA and Guyanese Government Partner to Combat Parasitic Diseases, Nadia McGill, Reuters
Exciting News!
The Rotary Club of Chicago has presented Sabin Vice-President Dr. Ciro de Quadros with the Chesley Perry Award for Distinguished Humanitarian Service for global polio eradication.
Dr. de Quadros led the team responsible for developing a surveillance and response strategy to eliminate polio from the Americas. Based on the success of the polio eradication strategy, the World Health Organization (WHO) committed to the global eradication of polio.
Worldwide, polio has been eliminated in all but four countries: Afghanistan, India, Nigeria, and Pakistan. The Americas were declared free from polio in 1994, the Western Pacific region in 2000, and Europe in 2002.
“Ciro’s contributions to worldwide polio eradication efforts are immeasurable and he continues to be a defining advocate for polio eradication in the few places where the disease remains,” said Sabin President Dr. Peter Hotez. “All of us at Sabin congratulate Ciro on receiving this distinguished award. With the strong support of champions like Ciro, the eradication of polio can be achieved in the near future.”
The award presentation on February 23rd coincided with Rotary International’s 105th anniversary and a global call to “End Polio Now.” Landmarks around the world including, Chicago’s Wrigley Building; the Egyptian Pyramid of Khafre; Buenos Aires’ Obelisk; and the Taipei 101 building displayed an “End Polio Now” banner calling attention to the devastating effects of polio, a crippling disease that can be fatal and disproportionately affects children under the age of five.
In addition to Dr. de Quadros, notable figures in attendance for the award presentation and lighting ceremony included: Illinois Governor Pat Quinn; Chicago Mayor Richard M. Daley; the Reverend Jesse Jackson, President of the Rainbow PUSH Coalition; James Galloway, U.S. Assistant Surgeon General; and Ed Futa, General Secretary of Rotary International.
Tomorrow, February 20th, 2010, marks the second annual World Day of Social Justice. This event was created in 2007 to “consolidate further the efforts of the international community in poverty eradication and in promoting full employment and decent work, gender equality and access to social well-being and justice for all.” There are many ways to work towards those goals, but one of the most effective, and cost effective, is the elimination of neglected tropical diseases (NTDs).
To eradicate poverty and promote full employment, NTD treatment is vital in the developing world. If a person is suffering from lymphatic filariasis and has severely swollen limbs to the point of being unable to work, or have contracted trachoma or onchocerciasis and gone blind, it hinders their ability to earn a living. Infections from the soil-transmitted helminth family of parasites cause anemia and nutrient deficiencies in children, stunting their physical and mental development. One of these parasites, roundworm, can decrease the future earnings potential of an infected child by 43%. However, deworming not only prevents the developmental disabilities created by infection, but also has been found to decrease school absenteeism by 25%. If future generations are to break free of the vicious cycle of poverty and unemployment, then NTD treatment must be included in any efforts.
Photo courtesy of Lindsay Wheeler
NTDs also play heavily into issues of gender equality, as they tend to disproportionately affect women. In areas of great gender inequality, the social stigmas attached to the disfigurement, morbidity, and disability caused by NTDs tend to be especially isolating and ostracizing for women. Women who have suffered from disfiguring NTDs such as lymphatic filariasis or onchoerciasis have lost their jobs, lost their families, and even been prevented from seeking medical attention. Further, NTDs pose special risks to women sexually and reproductively. NTD infections cause women in particular to be especially at risk for sexually transmitted diseases. Genital sores on women caused by schistosomiasis have been shown to increase the risk of HIV infection threefold. Both schistosomiasis and roundworm have been linked to maternal anemia during pregnancy, leading to complications, as well as low birth weight and sterility. For gender equality to be reached, these diseases which disproportionately affect women must be dealt with.
Those two points together make a strong case for NTD treatment, but there’s even more to be said in terms of social well-being and justice. Nations which are unstable or volatile, such as Pakistan, Niger, or Sudan, tend to have a high NTD disease burden. That is no coincidence. NTDs breed the poverty and inequality that give rise to political instability and violence. NTD treatment would not only heal the sick and help the poor, but it would help to stabilize nations and entire regions.
So tomorrow, as you enjoy your Saturday, remember those less fortunate than you. Remember those for whom survival is a daily struggle, poverty an unavoidable fact of life, and political instability and violence an ever present threat. Then consider that treatment for the seven most common NTDs can be provided for only 50 cents a year per person. Consider all the good that can be done for such a small price.
The UN created World Day of Social Justice with an eye towards a better future. For that to be accomplished, NTD treatment must be part of the plan.
Surprisingly, modern science has thus far only successfully eradicated one disease—smallpox—but recent developments hint that the world is close to eradicating another devastating infection—Guinea worm. This parasite, which has plagued communities for centuries, causes painful wounds and has the potential to cause disability, infection, and death, but thanks to recent concentrated global efforts, Guinea worm may soon become the first parasitic disease to be eradicated.
One very encouraging sign came last December when the World Health Organization (WHO) declared that Uganda had successfully eradicated Guinea worm within its borders. Uganda—which saw its last case of Guinea worm in 2003—joins seven other nations formally certified by the WHO as having eradicated the disease. Even more encouraging is the claim that in 2009 Nigeria experienced zero cases of Guinea worm. This makes Nigeria the 14th of 19 nations previously identified as endemic with the parasite to have recently eliminated the disease within its borders. Should Nigeria continue to be free of Guinea worm for the next several years, it will be WHO certified as having successfully eradicated the disease. Considering that Niger had only 3 cases of Guinea worm in 2009, it’s clear that the campaign to eradicate Guinea worm has been a great success thus far.
And this success was the result of the combined work of the Carter Center, the United States Center for Disease Control, WHO, and UNICEF, as well as other organizations and individuals. With similar efforts, other parasitic worms, including those in the destructive soil-transmitted helminths family, could be controlled, and perhaps one day eradicated altogether.
Today, Dr. Peter Hotez was published in the current issue of Foreign Policy. In his article entitled “Gandhi’s Hookworms,” Hotez looks at “the deep connection between medical health and the promotion of international peace and security.” He notes that neglected tropical diseases (NTDs) are endemic in areas of the world that are major concerns in U.S. foreign policy. Dr. Hotez writes that, “The security risks created by high endemic rates of NTDs argue strongly for seeking low-cost solutions for their control and elimination.” Fortunately, some low cost solutions already exist and an individual can be comprehensively treated for just $0.50 a year.
The article goes on to say that while “given the geography of where NTDs are most highly endemic, the modest costs required, and the potential for promoting global security, linking NTD control and elimination with U.S. foreign-policy goals makes a lot of sense.” Dr. Hotez calls on the federal government to increase NTD treatment funding from its current level at less than 1% of the U.S. global health budget. “The low cost for NTD control and elimination efforts and the potentially high return in terms of global security suggest that such activities could eventually be integrated into the missions of the Department of State and the Department of Defense, especially as their policies relate to the OIC and nuclear weapons states.” With rising deficits and a need for concrete, results based programming, investments into NTD treatment and elimination will serve both the U.S. and our international counterparts well.
In their 12th annual list of Top Ten Humanitarian Crises, Doctors Without Borders/Médecins Sans Frontières (MSF) included a number of NTDs.
According to the press release:
“Other diseases, such as Chagas, kala azar, sleeping sickness, and Buruli ulcer continue to be neglected, with very few new commitments to expanding access to available treatment or carrying out research for much needed newer and more effective drugs.”
“The tremendous resources devoted to the H1N1 pandemic in developed countries illustrates the response capacity for global health threats when the political will exists,” said Dr. Fournier. “Regrettably, we fail to see the same commitments made to combat diseases claiming millions of more lives each year.”
Started in 1998, the “Top Ten” list “seeks to generate greater awareness of the magnitude and severity of crises that may or may not be reflected in media accounts.”
To view the press release and the “Top Ten” List visit: http://www.doctorswithoutborders.org/publications/topten/2009/
We applaud MSF for including NTDs in their annual list, and hope that more attention, advocacy and political will, will work towards preventing NTDs from being a humantarian crisis in the years to come.
Emily Cotter is a second-year medical student at George Washington University in Washington DC. This summer, through Global Network founding collaborator Helen Keller International, Emily worked on NTDs in Sierra Leone. Below is the final installment of her 4-part series detailing her experiences.
After working on the public health side of NTD control projects earlier in the summer, I thought it would be interesting to see the clinical side of the NTD world. Emmanuel, a Community Health Officer student (essentially the equivalent of a medical student) who works closely with HKI staff on NTD projects, was scheduled to work at a clinic in July. I decided to shadow him at the clinic for a couple of weeks, which brought me to Bo, the second-largest city in Sierra Leone.
The health care system in Sierra Leone is all fee-for-service. In many areas of the country the average income is $0.11 per day and the cost of seeing a health care provider is usually at least a couple of dollars. Due to this, most people don’t get the care they need and if they do visit the healthcare system they present very late when it is usually a dire emergency. Médecins Sans Frontièrs (MSF, also known as Doctors Without Borders) has been working in Sierra Leone since the beginning of the country’s civil war and supports a few clinics around Bo. The government runs these primary care clinics; however, MSF provides the medications and covers the patient fees at these clinics while also operating a secondary health care referral center. This referral center can accommodate minor surgeries and monitor cases of severe malaria, malnutrition and other complex health problems. Emmanuel was placed at one of the MSF-supported primary care clinics for his practical experience and I was very excited to have a chance to learn more about their operations on the ground – I’ve wanted to work with MSF for more than a decade!
Most of the pediatric patients who came to the clinic were either infected with Plasmodium falciparum (malaria) or were extremely malnourished. The rainy season had begun in Sierra Leone, which I learned brings with it malaria and malnutrition season. MSF operates both in-patient and outpatient therapeutic feeding programs so I saw quite a few very sick kids being treated for marasmus and kwashiorkor (different types of malnutrition). I was continually struck by the contrast between the health problems in the United States relating to obesity and the other side of the hunger spectrum that I witnessed in Sierra Leone.
There was an “unholy trinity” of childhood anemia etiologies: malaria, malnutrition, and helminth infections ravaged children and left many severely anemic. Some children had dangerously low hemoglobin levels – from 4.2 g/dl to 3.2 g/dl, and even as low as 2.5 g/dl! (Hemoglobin levels should be above 12 or 13 g/dl; it is usually considered an emergency if they fall below 7 g/dl.). A young child actually died at the clinic one day; she was incredibly anemic, had severe malaria, and went into heart failure. Clinic health care workers typically send the kids with low hemoglobin levels to the MSF referral center where the children receive a blood transfusion. Given the lack of infrastructure and reliable access to electricity, no large blood bank exists in Sierra Leone. Instead, parents are asked to donate blood for their kids if their blood type matches. Another child with a dangerously low hemoglobin level came to the clinic the afternoon the girl died and no family member was able to donate blood for her. Being O+ and an almost-universal donor, I gave a pint of my blood for her. The blood draw was not the greatest, so for the subsequent two weeks my bruise was a visible reminder of the devastation of tropical diseases in this region of West Africa.
Emily Cotter is a second-year medical student at George Washington University in Washington DC. This summer, through Global Network founding collaborator Helen Keller International, Emily worked on NTDs in Sierra Leone. Below is part 3 of her 4-part series detailing her experiences.
Sierra Leone pulled off its first national preventive chemotherapy campaign for schistosomiasis this summer and luckily my internship coincided with the timing of this event. I was able to spend a week and a half supervising the prophylactic chemotherapy (PCT, aka mass drug administration) program with the HKI program coordinator for NTDs, Mustapha Sonnie. This event was a huge undertaking: surveillance for schisto was done throughout SL and any district that had a prevalence of schistosomiasis (either mansoni or haematobium) greater than 10% was included in this drug treatment program. This turned out to be planning treatment for more than 640,000 children! Funding for this program came from USAID’s Neglected Tropical Disease program, with the funding passed through RTI (Research Triangle Institute) and HKI on its way to the Ministry of Health and Sanitation.
It was fascinating to see the implementation of such a large-scale public health campaign! Sierra Leone has previously implemented PCT campaigns for other diseases such as onchocerciasis, lymphatic filariasis and soil-transmitted helminths using an approach called Community-Directed Treatment with Ivermectin. This approach uses community-based drug distributors who are trained volunteers that distribute ivermectin and albendazole in their communities. The PCT campaign for schistosomiasis did not use these volunteers; instead, the Ministry of Health and Sanitation trained the peripheral health unit staff to distribute praziquantel using a height-pole for accurate dosing. Mebendazole was also given to children during this campaign so children were simultaneously treated for soil-transmitted helminths and schistosomiasis. Praziquantel needs to be given with food so funding was also distributed to provide a meal at school before children were given the medications.
Emily Cotter is a second-year medical student at George Washington University in Washington DC. This summer, through Global Network founding collaborator Helen Keller International, Emily worked on NTDs in Sierra Leone. Below is part 2 of her 4-part series detailing her experiences.
I spent a couple of weeks in the middle of the summer traveling around some northern and eastern areas of Sierra Leone doing more surveillance for schistosomiasis, this time for the type of schisto that affects the bladder (S. haematobium). These weeks of travel were filled with buckets of water for bathing, latrines with small rectangles for aiming, and local “chop” for eating. The dusty and incredibly bumpy roads (good for facilitating digestion) left me feeling filthy, but ah fo do (what can you do, in the local Krio language)…
My co-intern and I went to different schools to collect urine samples from kids and did our lab work in the field. We used pretty ingenious gear for this: a hand-cranked centrifuge and microscopes with mirrors on the bottom that utilized sunlight for the light-beam needed to look at the specimen. We would meet the primary schools in session and have the teachers randomly select 30 children for us to sample their urine for S. haematobium eggs. Once selected, we’d wait until mid-day to have the children run around and exercise for 5-10 minutes, then have them urinate into small plastic vials, a funny or uncomfortable task for them about which they were good sports! Once we had the specimens, we set up our make-shift travel lab and worked outside, leaving me with a stellar tan line going from my elbows down to a line where the latex gloves stopped above my wrist. After we were done with the work we would drive to the next chiefdom, meet with the local Paramount Chief (one of whom was wearing Obama flip flops!) to introduce ourselves, then meet with the teachers and health clinic staff who would find us a place to stay in the village for the night.
» Read more: “Going Up-Country”: Part 2 of a Student’s Perspective on NTD Fieldwork
Emily Cotter is a second-year medical student at George Washington University in Washington DC. This summer, through Global Network founding collaborator Helen Keller International, Emily worked on NTDs in Sierra Leone. Below is part 1 of her 4-part series detailing her experiences.
I began my summer project in Sierra Leone with sweltering heat, a light microscope and stool samples. I had no idea what to expect when I agreed to come to Sierra Leone to work with Helen Keller International (HKI) on a neglected tropical disease (NTD) internship: when planning my project with the HKI Country Director in Sierra Leone we agreed that flexibility would be paramount. I was looking forward to being spontaneous when it came to projects – it was going to be a welcome break from the routine and scheduled life of my first year of medical school. Even still, contributing to schistosomiasis and soil-transmitted helminth surveillance through stool sample microscopy had not been anything I’d anticipated! However, here I was at Fourah Bay College sweating in my white lab coat, crossing my fingers for a slight breeze while bent over a generator-powered microscope looking at Schistosoma mansoni eggs in stool samples.
» Read more: “A Very Different Field Experience”: Part 1 of a Student’s Perspective on NTD Fieldwork
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