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Dawn, you have done more reading on this than I have! I like your comments on Covid and the potential for transition of Covid resources to fighting TB. Let’s hope it happens. We have both talked about the need for investment by the international community in measures to improve health, standard of living, etc, in the developing world. But back to Covid, I worry that the economic impact of Covid, which they say will take years to overcome, will negatively impact future investment by wealthy nations in the developing world, as well as the ability of developing nations to even maintain what they have already achieved. I think we may lose ground before we gain.
I just wrote an answer to Q2 regarding neglected tropical diseases and clicked on submit but it didn’t post and the answer disappeared. Here is a brief summary. I don’t think I’ll have time to recreate the full answer. From now on I’ll use Word, then copy and paste!
1. Address the G20 nations who have lots of NTDs (including India, China, Indonesia, Mexico, Brazil, Turkey, S.Africa). Eg: Chagas disease, with most cases in 3 of the G20 nations (Mexico, Brazil, Argentina). Late treatment is ineffective so education, disease monitoring, and early treatment are needed.
2. Female Genital Schistosomiasis (FGS). Apparently often under-diagnosed and mis-treated with significant resulting disability and suffering. Needs education of health care workers in affected areas. Also control of schistosomiasis with improved sanitation, clean drinking water, hygiene education, and periodic treatment of high risk groups with praziquantel will reduce the burden of this disease.Q1: Poverty and TB
People living in poverty are more likely to suffer from TB. There are several reasons for this, including, among others:
• Living in close proximity, allowing easier transmission through respiratory droplets
• Higher incidence of HIV which itself is a risk factor for TB due to immunosuppression
• Malnutrition resulting in greater susceptibility
• Lack of access to proper treatment of TB, perpetuating the cycle of disease progression and transmission.
• Failure to complete treatment due to finances, lack of understanding, competing priorities.How does this influence efforts to control the disease?
• First, many living in poverty live in poor nations who cannot afford the programs and drugs needed to manage this. Therefore, it requires the commitment of wealthy nations to contribute significant finances to global efforts to control TB, ensuring availability of sufficient drugs, and oversight/support of national treatment programs.
• On a broader level, there needs to be greater investment in efforts to address poverty, which in turn will reduce the incidence of TB. This is obviously a complex issue with no quick fix. But improved housing, better nutrition, regular employment, etc, will all result in greater control of TB. This is true for all nations since even wealthy nations have segments of their population living in poverty such as some of the indigenous populations of nations like Canada and USA.Hi Erika. I like your comments regarding the importance of having a national, organized, effective response to outbreaks. However, based on what we have been reading, it sounds like outbreaks are difficult to control in non-immunized populations. So while its certainly true that outbreaks need to be managed properly, the emphasis needs to be placed on effective immunization programs to ensure mass immunization which will prevent these outbreaks from occurring.
Response to Q2, re barriers to measles elimination:
Immunization appears to be the most effective way to eliminate measles. Barriers to effective immunization are multiple but could be grouped into problems of supply, delivery and reception. Presumably there is sufficient global supply of measles vaccines, but if not, this obviously needs to be addressed. However there are many challenges in delivering 2 doses to all those who need them. These include inadequate health infrastructure, lack of govt commitment/investment, political instability and in particular war, etc. Reception among the targeted population may be affected by distrust, false understandings, etc. Measures to address some of these issues include greater promotion of measles eradication by global health bodies, investment of finances, training +/- personnel directly in national vaccine programs, provision by the international community of vaccine clinics to displaced populations, health education (specifically re measles and generally re vaccines) for health workers and especially for under-vaccinated populations.In addition to enabling sufficient double-dose vaccination, there also needs to be close surveillance to identify any outbreaks and a well-organized, well-supported response where any occur, to limit the impact and to identify reasons for the outbreak which can then be addressed. Again, investment by global health agencies to educate and support such programs is crucial.
I’m not sure how much is expected for these questions, but here is an attempt at Q1.
There are multiple threats to world-wide food security. All are complex and difficult to resolve. Some of these are:
1. Climate change resulting in decreasing agricultural yields as a result of dryer climate and water scarcity, higher temperatures, loss of crop pollinators, more natural weather disasters, etc. Current global attempts to limit climate change must be sustained and further developed, with greater commitments from national governments and incentives to do so.
2. Ongoing armed conflicts are a major cause of food insecurity as a result of population migration, most being refugees; destruction of agricultural lands and disruption of agricultural activity; diversion of govt resources and priorities. Efforts to intervene in these conflicts and restore some degree of stability in these countries must be pursued, accepting some cost to the global community (eg through peace keeping forces, help resettling refugees, etc).
3. Government corruption leading to less investment in infrastructure, agriculture, education, health, etc, obviously will have a negative impact on food security. Also, corruption will lead to misuse and redirection of international aid, including food aid. Putting in additional measures to increase accountability may be helpful up to a point but this is a difficult societal issue to resolve.
4. As we are currently discovering, global pandemics affect food security for many. Hopefully what we are now learning about how to control the spread and the impacts of pandemics will be helpful in the future.The above are just a few areas needing attention. Research and development in all these areas as well as into better agricultural and food production methods, proper land development, etc, suitable for developing nations, needs to be promoted and supported by the international community.
Hi. I am a general surgeon working just outside Toronto. I went to India and Nepal as a medical student, then surgery resident. And I took my family to Pakistan for 2 months twice, over 10 yrs ago, to work in a mission hospital. I think God may be sending me back out so I want to be better prepared, and hence this course. I’m looking forward to learning with you!
Hi. I am a general surgeon near Toronto, Ontario. I did electives during medical school and residency in India and Nepal. And then in 2004 and 2007 I went to Pakistan for 2 months each time to help in a mission hospital (where I met Dr. Scott Armistead who is listed as Inmed faculty). I sense God may be pushing me in that direction again so I am taking this course to be better prepared next time. I am considering another short term trip, this time to Zimbabwe, but nothing confirmed yet.