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Question #1: From your perspective, why are people living in poverty most likely to suffer from TB, and how should this fact influence efforts to control the disease? People living in poverty are more likely to live in close proximity and crowded areas leading to increased transmission. The symptoms of TB can be insidious and poor access to primary health programs will make the detection of TB very difficult leading to more transmission while left untreated. Treatment can be expensive and difficult to come by especially in areas with drug-resistance requiring newer generation medications. I think a large effort should be placed on improved detection and diagnosis. We can’t stop transmission if we don’t have a good idea of who is infected. Post-exposure prophylaxis should be widely available as should primary medications for treatment. Cost is always an issue. However, if systems were more proactive and less reactive, I think in the long run they would actually save money by detecting and treating disease earlier in the course.
Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases? We need more R&D efforts and overall awareness. I’m thinking about NTDs and their relationship to other tropical diseases that aren’t necessarily considered “neglected”, the article mentions AIDS, TB and Malaria. The current approach with R&D seems to be triaging diseases. This may be the correct approach, I don’t know enough about the topic but I can see how it may be necessary to triage disease just like we triage other things in healthcare when working with limited resources. That being said, if we triage disease, there should be very clear goals for Malaria, TB and AIDS and at what point in our progress can we shift funding from those diseases to the NTDs. The easy answer is that we need more funding. However, it is conceivable that we would need to go “all-in” on malaria and once we achieve a certain goal, start to divert funding to schistosomiasis for example. The goal for R&D needs to be clear though, so that the goal posts don’t continue to move. Secondly, in order to achieve more funding for R&D on the NTDs, there should be continued efforts made to globalize knowledge about NTDs of regional importance. We live in a world where social movements and the use of technology can bring much needed attention and donations to causes overnight if given the right media exposure.
Lucio, thanks for elaborating more on crop legislation, something I don’t know much about but see the importance. We should really be incentivizing variety in crops and rotation like you said.
Lois thanks for your discussion. I definitely agree with your first point about increasing research and development of high yield and high nutrient crops. That isn’t something I have given much thought before, so thanks for bring that up. I also like your thoughts in the second question about community health clinics and building trust (Workers’ own children are vaccinated etc.). This is a strategy I use regularly in clinic when talking to hesitant families about vaccines, I always try to subtly or sometimes no so subtly mention that my own child has received all the same vaccines in hopes to build a trusting relationship.
Question #1: What system-wide changes, in your opinion, would most successfully increase world-wide food security?
I think one of the most important system-wide changes for both food security and the environment is to continue promoting and supporting eating locally farmed foods. The amount of environmental damage caused simply by the mass production of single crops and the shipping of these goods around the world is immeasurable. By eating more locally produced foods we support the local economy and decrease environmental waste. If food must be brought in from outside the local community it should only be food that is high in nutritional value and can not be physically grown in the local community because of prohibitive environmental factors. I also know that beef production is very damaging to the environment and the amount of water and land required to raise beef cattle may not be a sustainable process for our planet any more. This is more in the context of massive factory farming and not beef cattle raised locally. That land and water could be more efficiently used for nutrient rich crops to address world-wide food security.
Question 2: What do you believe are the most substantial barriers to global measles elimination, and how can these be overcome?
I believe war and violence are substantial barriers to the global elimination of measles. Unfortunately the cost of war is difficult to assess but it has an impact on vaccination rates and therefore impacts the progress towards measles elimination. I think it will always be important to consider immunizations as an absolute necessity when providing aid to countries impacted by violence. Classically I think of medical aid in these situations being acute care for acute problems, but there should be an emphasis in all outreach efforts on the importance of immunizations for long term benefits to the community. There also seems to be a problem with some portion of the population not taking measles seriously. I think we should continue our education efforts in all parts of the world even those with strong vaccination rates because the slide towards complacency can be quick as evidenced by some of the resurgence of measles cases in previously well immunized areas of the United States.
Hello, my name is Gregor. I am a 3rd year Family Medicine resident physician training in Bremerton, Washington. I graduated medical school from Saint Louis University in 2020 and I will graduate residency this coming June. I am taking this course because I am interested in learning more about providing medical care in other parts of the world and in other cultures. I am a generalist at heart and so the more I learn about other practices, patient populations and regions of the world the more well-rounded I will be. In the future (next Spring) I will be traveling to Honduras for a month long elective rotation as part of my residency. I hope to practice in both a hospital setting and clinic setting after graduation and will be incorporating international healthcare into my family’s future.