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Strongly agree about “women’s empowerment” being a huge needed intervention! An educated mother will care for her children in the very best way, as well as have potential revenue-earning opportunities to care for the family. She would also have input into family planning, which affects the family’s prosperity as a whole.
Q1 – TB and poverty. TB is an extremely resource intensive disease, requiring complicated diagnostics and prolonged therapeutics. All of this requires a very robust medical infrastructure. I found it interesting that the article called several times for “ramping up” efforts; and that goals require “additional funding” and “more robust partnerships between research funders and research groups.” It makes sense then that impoverished communities will not have the community clinics, screening programs, testing, and therapeutics (with +/- direct observed therapy for 9-12 months) necessary to affect disease morbidity in these communities. The article also mentioned that some TB resources and infrastructure were allocated to COVID; I see another layer being that the pandemic itself caused a global “tightening of the belt”, with limitations in research and humanitarian dollars being specific examples. (This is very different from the “golden years” of the 90’s with ample research money coming from private foudnations and governments, for example to combat HIV, and this should be a wake-up call.) A potential solution could be to privatize efforts to control disease. (??? Big question marks because not sure this would be effective, but we have seen this shift from government to private companies in the space-travel industry). Private companies have resource, innovation, and infrastructure, but they would need incentives from governments to allocate those resources to humanitarian efforts, put simply these are usually in the form of legislated tax breaks.
This response resonates with a lot of wisdom! Taking ownership, following proven standards and guidelines, and investing in preventative measures all require a bit of “up-front” work and resource, but then the “down-stream” payoffs are huge – a safer community and less disease burden needing expensive or unavailable treatments.
#2 (Neglected tropical diseases). The article’s description of the WHO initiatives from 2005, coupled with large-scale pharmaceutical donations and recruitment of local healthcare delivery infrastructure to provide curative and preventative treatments, truly is a triumph of modern healthcare. Now that the “low-hanging fruit” has been tackled, it seems like the next interventions should be: 1) Continued research and development of novel treatments for diseases without an easy or available treatment. (The article lists: echinococcus, foodborn trematodes, rabies, and cysticercosis as examples.) This can be facilited through continued partnership between the private sector and government. For example, the government could legislate incentives (i.e. tax breaks) for private pharmaceutical companies (Bayer, Pfizer, etc) to develop and then donate R&D and medications. Another strategy could be for legislation to place a “cap” on profits that big pharma can realize – similar to caps imposed on private health payers like Blue Cross Blue Shield – with additional profits mandated to be funneled into R&D and distribution of medications. 2) Continue efforts to provide clean water and sanitation to areas of poverty, as it seems like this is a root cause of many of these diseases.
#2 I think the biggest barrier to a measles-free world is that it seems like, with a highly contagious disease, essentially everyone on earth will need to be vaccinated in order to eradicate it, which is not possible. (If you look at systems with rare, yet catastrophic events – like the Toyota “six-sigma” production model or the aerospace industry – it turns out that it is impossible to completely “eradicate” rare events, even with the best system design – in this case the rare event being an unvaccinated person contracting the disease). Regarding measles vaccination rates, there are the limitations of availability of the vaccine. The world also experienced a major set-back during COVID regarding information about vaccines. (An attenuated virus vaccine is VERY different from a modified m-RNA vaccine). The policitization of this messaging – even calling detractors peddlers of “misinformation” – will result in vaccine hesitancy for many years. This will need to be overcome by: 1) a return to honest messaging about the real science, risks, and benefits of vaccinating and 2) education around the different ways that different vaccines work – essentially a large media campaign (but not funded by Pfizer).
#1 Wow what a difficult issue to try to tackle! I thought the article was well-written and thought-provoking, and I agree with all of the comments about the complicated layers of problems needing to be solved, in particular the disruptions caused by military conflict. I couldn’t help but think that the best and first solution needs to be better data. It seems that the current landscape of the data is either not granular enough (i.e. too “big picture”, like the big red swath through the continent of Africa, rather than information on a community-level); or the data might be subject to selection or observation bias (i.e. obtained through the lens of climate change as the root cause, or only sampling a small number of communities, or only those with access to reporting mechanisms.) With such a complicated issue that is extremely variable depending on the location, data collection would need three things:
1) A community food security “champion”, maybe even an elected official, who has access to –
2) A data collection toolkit which would map a community’s food from farm through distribution to store to table. This could illuminate the unique barriers and problems needing to be solved for that community. (I remember doing an exercise like this for patient flow through the ER, a very tedious “map” which identified inefficiencies in the complex system of the ER – for some it was lab, others registration, others radiologist readings of CT scans – which all had unique solutions.)
3) The community food security champion would then need a mechanism for reporting the data to different tiers that would be able to implement solutions, on a local, state, country, and even world-wide oversight body level.Wow what a hard topic!
Hello! My name is James Vincent. My training is in emergency medicine and pediatric emergency medicine. I did my residency at UT Houston, graduating in 2003, then did my pedi ER fellowship at Texas Children’s Hospital. I helped set up a pedi ER at a community hospital and was director for 8 years. I then moved to a “free-standing” ER in the suburbs of Houston, where I now practice part-time. (Admittedly, I suffered from burn-out and this has been a very refreshing, if maybe a little boring, season for me.)
I have taken several short-term mission trips – including Mexico, Central America, Haiti, and Kenya, and even led a trip with my wife for a group of medical students. (She is an OB/Gyn physician researcher, and we met in medical school). With the birth of my third child, I felt God ask me to take a break and focus on my growing family.
My youngest is now 12, my older two children being in college, and I feel the season is changing again, and God asking me to start to prepare for international medicine. My dream would be to work for Samaritan Purse’s “DART Team” providing disaster medical relief. I could imagine my “empty nest” season to involve part-time ER work and travel overseas. I have about 5 years until my third goes off to college, so I am interested in this course material as my first step. I am also brushing up on my Spanish and trying to learn French.