Stopping Cholera in Haiti

The recent emerging outbreak of cholera in the devastated country of Haiti highlights the importance of access to medical treatments in prevention of disease spread.

An article from Newsweek emphasizes this theme in public health: http://www.newsweek.com/2010/12/13/how-to-stop-cholera-in-haiti.html

The article begins by pointing out the potential health threat this outbreak is to us Americans. Proximity and trade agreements throughout Central America as a result of NAFTA make disease spread through North America a realistic and potentially rapid threat. The health threats of our neighboring countries should be considered a threat to our country, especially as viral disease have the capacity to evolve and develop into new strains. As witnessed from the swine flu epidemic last year, the US has the resources to respond to a spread of disease throughout this country. But, if the purpose of public health is to prevent the spread of disease, shouldn't we as a society seek to prevent the spread of disease to our shores by attacking the problem at its core: lack of infrastructure, sanitation, and medical treatment in Haiti.

While it's easy to dismiss the cholera outbreak as a problem for Haiti, the article cites the ability of such diseases to spread around the world as a reason not to discriminate diseases and countries by economic welfare - as exemplified by the success of HIV programs in diminishing the prevalence of HIV in Haiti. The same should be applied to this recent epidemic. The article cites the need for cholera vaccine to be exported to the country, but poses the barrier of cost to treating cholera. But does the cost outweigh the benefits? Would the price of letting this cholera epidemic outweigh the cost of aid given in preventing the spread of disease? I personally believe from a political and economic standpoint it makes sense to ensure the health of the country. Politically, a cholera outbreak that has already led to 2,000 deaths in the past month threatens to ruin the stability of the region. Economically, treating the country's 10 million is more sensible than potentially treating 300 million plus people in the US and throughout North America.

I suppose the real question is what is the role of those who have in dealing with the plight of the have-nots. The issue thus becomes one of social justice. The treatments all exist. We know the importance of sanitation and infrastructure and the helpful role of antibiotics and vaccinations. Yet the system is willing to deny access to these life-saving procedures. Personally, I think access to these treatments should be granted to those who want them, and while economically it may not be cost-effective, the cost of tackling a global outbreak of cholera could prove much more costly.

Empower Women to Enable their Communities

An article in the New York times reported on an interesting community approach to infant mortality.
A recent study published in the Lancet http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962274-X/abstract investigated the efficacy of a program to train and sponsor lady health workers to enact community interventions in Pakistan. The lady health workers program was developed in Pakistan to reduce perinatal and neonatal morbidity in rural areas of Pakistan where 57% of deaths before the age of five are attributed to newborn morbidity (Bhutta et al, 2011).

The results of this study are promising. Since the lady health workers program started, the communities where these women worked have experienced a 15% decrease in newborn deaths and 21% decrease in stillbirths. The program attained these successful results despite the fact that the lady health workers were not able to perform all of their assigned duties and failed to follow through on several post-birth baby visits.

More impressive than the results, is the fact that this program required minimal expertise and training from the women health workers. The lady health workers had on average only a tenth-grade education and only participated in one week of training before the program started. Their duties included distributing soap and clean razors for sterile cutting of the umbilical cord, and instructing midwives on the importance of keeping newborns warm and how to give them mouth-to-mouth resuscitation.

Two organizations partnered to fund this study: The World Health Organization and the Saving Newborn Lives Program of Save the Children which is funded by the Bill and Melinda Gates Foundation.

I believe much of the success of this program could be attributed to the fact that lady health workers easily earn trust from females in the community. Any scientific discovery, whether epidemiological, biomedical, or environmental, is nothing if the people its results affect will not buy it. This program's efficacy is evidence that social connections between women in communities are perhaps the most valuable circuits through which public health endeavors can communicate. I am excited to see how the results of this study shape community interventions for reproductive and maternal health across the globe!

Article Link: http://www.nytimes.com/2011/01/25/health/25global.html?ref=health

Stigma Haunts Mentally Ill Latinos

The frequency of mental illness has steadily been increasing, but despite the prevalence of it in the world, there is still a great stigma attached to these illnesses. Many advances have been made in diagnosing patients that have a mental illness as well as the development of many new treatments. Despite the increased awareness, stigmas are still very prevalent in America, especially in the Latino community. When only 20 percent of Latinos with a mental illness receive treatment compared to 60 percent of Caucasians, there are many aspects contributing to the problem. These include things such as cultural and socioeconomic factors.

An issue that effects many people in America today, especially Latinos, is a lack of health insurance. A huge barrier is raised to fixing this problem of mental illness when only 66 percent of all Latinos have health insurance, and of that 66 percent, only 41 percent have mental health coverage. I hope the new healthcare legislation will provide some assistance in this area. I believe it is unacceptable to have less than half of Latinos that actually have health insurance to not have mental health benefits. I'm sure the problem of lack of coverage for mental health illnesses covers many people in America other than Latinos as well. This continues to show that throughout all of society, there is still a stigma and lack of understanding about mental illnesses as a whole because so few people lack the coverage they need to receive treatment.

One of the interesting things the article points out is how the Latino culture hinders the treatment of mental illnesses. Their deep religious culture causes many Latinos to go to their church for help dealing with the illness instead of contacting a physician. The culture also puts a huge emphasis on a person being able to deal with their own problems instead of reaching out for help. While I do believe this is a problem for many other people outside the Latino community as well, it seems this self-reliance is an even more important part to the Latino culture that effects their desire to seek out a physician and treatment. It is very difficult to change the culture of a group of people as a whole, but increased education to Latinos about the risks of mental illness and the available treatments would be a start to having more people become aware of the problem, and hopefully taking steps towards treatment of everyone that suffers from these illnesses.

After reading this article, I have become more aware about the effect stigmas can have on a population as a whole. I think the stigma regarding mental health is well documented, and hopefully the increased attention has started to slowly take away those stigmas from our society. Sometimes it is easy to shift blame onto the people with these diseases for not seeking out treatment, but we do this without realizing the cultural and social barriers many Latinos face even after acknowledging their illness. After educating the community as a whole, what other measures can be taken to rid the stigmas and resistance to treatment we see in the Latino community? Also, how do we ensure there are enough resources for a Spanish speaking person to receive treatment? A language barrier is almost impossible to overcome when treating a mental health issue because of the complexity that goes into the diagnosis. It is the responsibility of America as a whole to make sure that we don't neglect the needs of a certain community around us, but instead make ourselves aware of the problems and strive to fix them in any way possible.

Link:http://www.cnn.com/2010/HEALTH/11/15/latinos.health.stigma/index.html

New Pneumonia Vaccine Launches Today in Africa

Starting yesterday, 19 countries including Kenya, Yemen, Honduras, and Sierra Leone, had begun administering new vaccinations for pneumonia in an attempt to work towards the UN's Millennium goal of reducing child mortality by two-thirds. For many, this is a first-time chance to vaccinate a child or family member, yet this effort is not coming without its challenges.

The immunizations are being directed by the GAVI Alliance, or the Global Alliance for Vaccinations and Immunizations. In areas of the world such as sub-Saharan Africa, pneumonia is affecting the most people, with global deaths around 1.6 million children and 18% of all children deaths. With these new vaccines, GAVI believes that more than 1 million children can be save annually.

Yet the challenge to roll-out the immunization on such a large scale faces many daunting challenges. Aside from the mere scale of the operation, costs and backing have become an issue for the effort. The article points towards one example from the BBC that highlights the large cost disparity between the same drug in different countries. According to the article, "The pneumococcal vaccine costs £2.20 ($3.50) in Africa compared to £38 in Europe as a result of a deal between Gavi and two manufacturers: Pfizer and GSK". This kind of gap in vaccination costs only prolongs the vaccination protection of children around the globe.

After the assignment we received in class today and seeing this link online, I became aware of how quickly the ideas of global health are growing globally. Not only is it our responsibility to be aware of the struggles communities face, but to do everything in our power to aid them. It also good to see that organizations are able to receive the support from companies and countries necessary to complete such a large-scale goal. It seems that as populations continue to boom worldwide, countries are becoming more and more aware of how much damage disease can do to a country's stability and economy.

Yet the struggle for equal and adequate care continues. As stated in the article and video, in order to complete the goals set by the UN's Millennium goals, pharmaceutical companies must be willing to cut costs in order to make the vaccine available for wide-scale use. Hopefully through diligent diplomacy and policy-making, law-makers and drug companies can come to terms that make vaccines, such as this new pneumonia vaccine, available to everyone.

Link: http://www.good.is/post/new-pneumonia-vaccine-launches-today-in-africa-lives-will-be-saved/

Catching Criminals to Cut the Cost of Care?

Fraudulent Medicare billing would have cost the U.S. 4 billion dollars between Oct 1st, 2009 and Sep 30th, 2010, if the department of health and human services had not worked with the Justice Department to bring the HEAT (Health Care Fraud Prevention & Enforcement Action Team) on fraud. http://money.cnn.com/2011/01/24/news/economy/health_care_fraud/

When I typically think of committees aiming to reduce the cost of health in the U.S., I imagine a team of professionals sitting in large office chairs around an oval table deciding which scans, procedures, and patterns are most expensive, questioning whether or not they are necessary, and then attempting to create algorithms around them. Until I read this article, I did not realize that cutting healthcare expenditures could entail processing and screening a mass of insurance claims to find patterns that would indicate someone, who may not even be a health practitioner, is using patient information to steal money from the government.

Health fraud is not limited to the U.S. This article on NPR: http://www.npr.org/blogs/health/2011/01/24/133188263/global-health-fund-finds-some-fraud-recoups-losses explains that workers pocketed some 34 million dollars belonging to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. It is infuriating that anyone would steal money intended to improve health conditions globally.

This article mentioned that health funds are particularly vulnerable to fraud. It is easy for money to slip through the cracks when it is transfered from group to group. The Fund's executive director said they devote a lot of energy to discovering any misuse of funds. Might it be useful to devise methods for preventing money leaks before they happen rather than uncovering them after the fact? Would this even be feasible?

These articles broadened my perspective on the economic aspects of health. I wonder, what are other non-traditional ways of reducing health spending?

Shell Shocked: Do the Taliban Get PTSD?

Mental health issues seem to have become a growing concern in the last couple of years with the rise of ADHD, bipolar disorder, and depression. Whether the cause of this growth is an increase in the diagnosis of these disorders or an actual rise in prevalence is unclear, at least to me. I think that in the US, mental health has become an especially prominent issue. Many other countries really do not have the luxury to consider mental health issues when they are struggling to provide health care, let alone food and water.

The social and cultural stigmas that surround mental health may have begun to decline, but as this article makes clear, they are far from gone. The article describes how traditionally Afghans regarded mental health issues as embarrassing, as the fault of the person suffering the condition. While the US has begun the process to provide better mental health support for its armed forces (especially when considering some of the recent shootings and the rise of military suicides), many countries still do not grant mental illness legitimacy, making it even harder for individuals to find treatment. The Taliban apparently refuse to aid those families who have a member that suffers from mental health issues caused by the war, unless there's a physical injury. Even when the families try to help those affected, I have to wonder what kind of ability they actually have to do so--especially in this case. The Taliban have made clear their stance on gender equality, and with most of the combatants being male, I would think women have little to no ability to seek treatment for their husbands, fathers, and sons if they do not willingly accept it. The refusal of care is even more difficult to avert here in these countries disrupted by warfare and government instability, because proper education is not in place which gives rise to stigmas and disbelief. But clearly, mental health issues are just as dangerous and as real, if not more so, than a physical condition.

Another good point the article makes is bring to light the culture of violence and upheaval that war-torn countries or countries lacking stability (in government, in economy, etc.) face. Colombia is similar in this respect, in that they now have a growing mental health problem from the years of FARC/ELN/government drug warfare. The Middle East clearly will suffer from the remnants of war and upheaval for years to come, and not just fighters but citizens too. This is one of the inevitable side effects of war that I think often gets over-looked--war creates this culture, especially when the odds are so uneven. You take a country like the US with all of this access to weaponry and an "advanced" health care system and compare it to countries like Afghanistan, Pakistan, Iran, Iraq and others who not only have limited military resources, but also disorganized often corrupt governments and little to no access to health care. The disparities that exist country to country, and even state to state to some degree, amaze me.

While thinking all this over, I can not help but sympathize with the families of the Taliban. At the same time though, I recognize the rage that many Americans feel towards those fighting against us. It brings about the question that if these people's governments and organizations won't provide adequate care, then who's duty is it to do so? And as much as I know it's an impossibly idealistic thought, I would like to think that we share a common responsibility to better humankind's plight, enemy or friend. Is there a cost-effective way to do this, is it achievable? I have no clue.

If people come away with anything from this article though, I hope they realize that PTSD and other mental health issues are real, viable concerns, regardless of who they affect, and that war has very real effects for those who take part in it.

Link: http://www.newsweek.com/2010/12/06/do-the-taliban-get-ptsd.html

Cholera in Haiti: Barriers to Vaccination

Haiti's first ever battle against Cholera started on October 21st of 2010. In less than three months the bacterium has killed more than 3,800 people. This article the debate among international health agencies over efficacious use the Cholera vaccine.
There are roughly 300,000 doses of the vaccine available to administer to a population of over 10 million. As the article emphasized, there is currently not enough vaccine to immunize the entire country.
It would seem logical to give the vaccine to individuals in areas at highest risk. Would it be wise for health professionals to arrange the vaccination program to give to individuals who would have the most difficulty getting access to medical care if they fell sick? If that is the case, who are those individuals? Are they the children living in post-earthquake slums in Port-au-Prince? Should efforts focus on vaccinating rural communities located far away from any hospitals?

I wonder about the administration of the vaccine itself. Dukoral is drinkable, safe for children and reported to be 85% effective. Even though the vaccine is drinkable, I have witnessed the difficulty of coaxing two, three, and four-year olds to swallow any medication. Imagine if 10% of all children who receive the vaccine spit it out or spit it up. What then?

Also, the vaccine requires two doses. How will the vaccination campaign ensure compliance through the second dose?

On another note, I was surprised by an opinion expressed in the article. Jon Andrus, the deputy director of the Pan-American Health Organization said he does not expect the vaccination program in Haiti to have a substantial effect on the health of Haitians but is nonetheless interested as its administration will provide further data on the vaccine's efficacy. I understand his interest in research, but should PAHO not focus energy and resources on finding a way to have a major public health impact on Cholera in Haiti rather than acquiescing to inadequacy and shooting to gather data instead? Other authorities, including the vaccination program minister agree that any vaccination should be carried out on a large enough scale to have an impact or not be carried out at all.

Here is the article:
http://www.nature.com/news/2011/110118/full/469273a.html

Here is some information about the vaccine:
http://www.crucell.com/Products/Dukoral