Monday, March 25, 2013

The Disease Next Door - By Peter Hotez | Foreign Policy

An article posted today in Foreign Policy discussing how most cases of the worst neglected tropical diseases are now found among the extreme poor tho live in the world's wealthiest countries.

The Disease Next Door - By Peter Hotez | Foreign Policy

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In a country well governed, poverty is something to be ashamed of.   In a country badly governed, wealth is something to be ashamed of.
- Confucius

Sunday, March 24, 2013

Rescuing the Bottom Billion through Control of Neglected Tropical Diseases


My past experience working at NIH and in the Montgomery County Refugee clinic helped to fortify my desire to work with these diseases and the population of clients they represent - however - it was a particular lecture I attended several years ago that grabbed my attention and increased my understanding of just how significant these diseases were and what a detrimental impact they could have on individuals and society as a whole.

That lecture was presented by Peter J. Hotez, M.D., Ph.D.   When he spoke, he delivered his message with such a passion, is was almost palpable.   Here was a man who truly believed in his work and one who had a clear direction on what should be done to help these people.  I walked away from that lecture with a new awareness and awakening.   Over time I had the opportunity to attend a few more of his lectures and each time I left feeling the same way - enlightened, and with a desire to want to do more.   This is a man who truly wants to make a difference.

Below is a videocast of one of his lectures that was presented at the National Institutes of Health on April 22, 2010.   This is just one of many he has given over the years.   The runtime is a little over an hour.
Rescuing the Bottom Billion Through Control of Neglected Tropical Diseases 

Dr. Hotez has also written a book:  Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development.   It is available from Amazon.com

Finally, if you would like more information regarding Dr. Hotez, you can read his bio by visiting the Baylor College of Medicine website


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"Every great dream begins with a dreamer.   Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world."
- Harriet Tubman

Wednesday, March 20, 2013

What are Neglected Tropical Diseases?



Neglected Tropical Diseases or NTDs are a group of parasitic (protozoans, flukes, roundworms, tapeworms, flatworms), bacterial and viral diseases that afflict some of the world’s poorest populations.  They are particularly common in tropical areas where people have little or no access to clean water, minimal or no sanitation, have limited protection from disease vectors such as mosquitoes, flies and snails, have limited or no access to medical care and have little or no political voice.  Seven of the most common NTDs are found in a number of countries but are most frequently found in low and middle-income countries of Africa, Asia, and Latin America.

These diseases are non-discriminatory and affect men and women equally, young and old, with children being the most vulnerable.  Many of these diseases cause severe disfigurement and lifelong disabilities.  They can impede physical and cognitive development in children, adversely affect pregnancy outcomes and contribute to mother, infant and child illness and death.  Those affected by these diseases may find it difficult to attend school or work and may be shunned by their community due to fear and lack of understanding about these diseases.  This then affects the person's ability to obtain an education, earn a living, provide for their family and thus traps them in an endless cycle of poverty and disease.  

One may think these diseases are problems of “third world” countries, however, that is not the case.  Some of these diseases are found within the United States in areas of extreme poverty that include Appalachia, the Mississippi Delta, the American South, Native American tribal lands and the borderlands between the United States and Mexico.  Incidence of these diseases is also on the rise due to the increased number of immigrants, refugees and asylees seeking residence within the United States who arrive infected and untreated.   Still other cases, unrelated to poverty or immigration, are being identified in ecotourists, military personnel, missionary workers and volunteers who now have greater access to countries where these diseases are endemic.

Why are they considered “neglected”?
These diseases generally plague the poorest of the poor and those who are most in need of access to medical care, clean water, clean living conditions and improved sanitation.  These people usually have little or no political voice and, historically, have been overlooked, forgotten or "neglected" while other diseases such as HIV and Malaria receive worldwide attention.

How many people are infected?
According to the World Health Organization over a billion people or one-sixth of the entire world’s population is suffering from one or more of these neglected tropical diseases.

What are these diseases?
The World Health Organization (WHO) has identified seventeen chronic, disabling diseases that are in need of immediate global attention and intervention.
These are:
· Lymphatic filariasis (also known as Elephantiasis)
· Schistosomiasis (also known as Schisto, Bilharzia and Snail Fever)
· Soil transmitted helminthiases (intestinal worms such as Ascaris lumbricoides, Trichuris trichiura and hookworms),

The WHO has also identified five other 'neglected' conditions that need global awareness and intervention due to the high incidence of illness, chronic disability and death associated with them.  
These are:
· Podoconiosis (extreme swelling of the legs that is not caused by an infectious or contagious agent, parasite, bacteria or virus but instead is due to long term exposure to irritant minerals in red clay soils)
· Snakebite (disease and death attributed to venomous snake bites)
· Strongyloidiasis (chronic roundworm infection that can have devastating effects if the infected person has suppression of their immune system)
· Mycetoma (a chronic, progressive, destructive morbid inflammatory disease usually of the foot but can affect any part of the body - previously called Madura foot)
· Scabies (a parasitic infestation of the skin which triggers a host immune response that leads to intense itching that is then frequently complicated by bacterial infection, leading to the development of skin sores that, may then lead to serious consequences such as septicaemia, heart disease and chronic kidney disease.)

What can be done?
Many neglected tropical diseases can be prevented, eliminated or even eradicated with improved access to current safe and cost-effective interventions such as medication, mosquito nets and improved sanitation and drinking water.  At least seven of these diseases can be controlled and even eradicated by current approved, low cost medication that has few side effects, can be administered to adults and children and only requires as one to two doses per year.   Some of these interventions are so simple that non-specialists such as schoolteachers, village heads and local volunteers in community-based preventive action programs could carry them out.

Over the past few years these diseases have been gaining attention and there are now several groups who have formed initiatives to try to combat these diseases and improve the health of millions.   These organizations include the World Health Organization, the Centers for Disease Control in collaboration with the US Global Health Initiative or GHI, the Gates Foundation and the National Institutes of Health.

Despite this, more attention to these diseases and the people they affect is needed.  Without further awareness and intervention these diseases will continue to flourish, trapping the poor in a cycle of poverty and disease and devastating these people and their communities.

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"Action is a great restorer and builder of confidence.  Inaction is not only the result, but the cause, of fear.  Perhaps the action you take will be successful; perhaps different action or adjustments will have to follow.  But any action is better than no action at all."
-  Norman Vincent Peale

Monday, March 11, 2013

Why a blog site for Neglected Tropical Diseases?


I am a nurse with 20 years experience in infectious disease who specialized in parasitic diseases.  This line of work introduced me to persons from all over the world - some of whom were escaping war zones and others who were just looking for a more promising life in America.  Many were US citizens who moved to other countries to serve in the peace corps or work as missionaries, healthcare workers or wildlife conservationists.   Still others were diplomats, ecotravelers and tourists.   During this time I also attended many conferences that discussed the devastating effect some of these diseases had on people, their community and their country and how little it would cost to treat and eradicate them.  However, funding for treatment and eradication of these diseases has been hard to come by as the big money and celebrity endorsements continue to go to cancer, HIV, and malaria research.   And lets face it - parasitic diseases are not glamorous.

The idea for this blog is born out of my interest in parasitic diseases and my desire to help the people and countries affected by these diseases as well as enlighten others who have never heard of them.   I also hope to enlighten those in the general medical community who may be providing care for persons who, unbeknown to them, may actually have one of these diseases.

One may think that these are "third world diseases" and something the US should not pay attention to - especially when we have so many problems of our own.   However, that is not exactly true.  

According to the Migration Policy Institute (MPI)1, the immigrant population in the US as of 2011 was estimated at 40.4 million, which was a historical numeric high for the country and the largest in the world with about 20 percent of all international migrants residing in the United States.  And this is just the tip of the iceberg, as those numbers do not include those who have entered the US illegally or those who are seeking asylum or are categorized as refugees.  According to the UN Refugee Agency2 , in 2012 the US accepted more people for resettlement than any other country in the world.   As of January 2012 there were 276,484 refugees and asylees living in the US.   

Many of these immigrants (legal and illegal), refugees and asylees come from counties where parasitic diseases are endemic.   When a person who is infected and untreated comes to the US, it is highly likely that at some point in time they will become ill from their disease and seek medical care in a healthcare system that may not be experienced in identifying and treating the disease.   This in turn may lead to unnecessary testing and expense (of both time and money) thus further burdening our health care system.  And it is not just the influx of persons from endemic countries who import the disease.   Exposure and infection is also increasing in US citizens due to the popularity of ecotourism and volunteerism to endemic countries.   These diseases do not discriminate.  They affect infants, children, adults and the elderly no matter what their economic status, race or gender may be.

Again - the intent of this blog is to help shed light on neglected tropical diseases and not to cast blame or create distress or discord towards persons from other countries, the US healthcare system or the immigration laws.  This blog is meant to serve as a teaching tool with hopes that with more information there will be a better understanding of these diseases and a further desire to aide in funding to prevent and treat those impacted by them.

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"Knowledge becomes power only when we put it into use." 
 - Anonymous