KOLAHUN

Bangkok...shit!

 

Jubei (guest blogger): [voiceover]….I'm still only in Bangkok... Every time I think I'm gonna wake up back in the public health clinic, seeing patients, writing new blog entries. When I was there, I wanted to be here; when I was here, all I could think of was getting back into the clinic and into the shit. I'm here since “…Dengue Fever” now... waiting for KOLAHUN to post something new... getting softer; every minute I stay in this room, the blog gets weaker, and every minute Kolahun (host blogger) squats in New Orleans, seeing patients….deconstructing Laurie Garrett - he gets stronger. Each time I looked around, the virtual walls moved in a little tighter.  Time for my complimentary, Western-style breakfast...

Neglected Diseases - Dengue Fever

I'd have to say the adjectives used to describe Dengue Fever probably evoke the most Stephen King-esque associations in medicine I can think of.  First, the name itself, Dengue Fever, has quite a sinister twist.  Then there's the description of it as "break-bone fever" disease.  And finally, it's classification as a hemorrhagic fever brings back the horrific memories of the descriptions of hemorrhagic fevers in The Hot Zone. 

The disease itself parallels malaria in many respects.  There are four dengue virus variants (much like the four species of malaria), the virus is spread through a mosquito vector and the incubation period lasts between 3-10 days.  And like malaria, we've got no vaccine (yet) and some of the best preventive measures include mosquito control. 

Of course, while there are quite good prophylaxis and treatment options for malaria, there are none for dengue fever (except supportive therapy).  And there's that whole "hemorrhage" thing which one doesn't see with malaria. 

(pic from WHO)

Deconstructing Laurie Garrett (Part 6)

"Brain drain" captures the essence of this next segment of Laurie Garrett's Foreign Affairs article, wherein developed countries "poach" health workers from developing countries to work in their countries.  Or to work for foreign NGOs instead of native organizations or for the Ministry of Health.  This is clearly a bad thing for the health resources of developing countries.

But it's hardly a criticism of the health care worker.  Given the choice, I too would migrate to a country where I could get a stable income, where access to potable water/food/electricity was uninterrupted and where I could send my children to acceptable schools.  The criticism is in the development of either enough health care workers or in systems where we could leverage the nominally educated person to care for basic health needs. 

This overall lack of health workers leads to the ironic ruling of the British NHS to exclude non -British Commonwealth physicians (the majority of whom are Indians, but also include large numbers of South Africaners and Australians) in lieu of European Union physicians.  On the one hand, this probably helps the residents of India and South Africa and Australia who may need physicians.  On the other hand, it really sucks for those dudes who took the time and effort to migrate and have already penciled in a couple of years of NHS duty.  And really, are there that many European Union physicians and British physicians in the queue?  Where were they for the past 20 years? 

(Click here to read parts 1, 2, 3, 4 and 5 of this series.)

Deconstructing Laurie Garrett (Part 5)

This part of the essay deals specifically with Botswana.  Now, given that 1 of our 3 loyal readers recently returned from working in Botswana, where he spent the better part of a year doing an HIV/AIDS project, it seemed like a good idea for another guest post and a first-person account:

 

Over the past week this site’s host has been discussing Laurie Garrett’s 2007 Foreign Affairs article on challenges facing global health.  Part of the article focuses on the “success story of Botswana”. 

I lived in Botswana for 8 months in 2006 sandwiched between time living in Kenya and Tanzania.  I worked in the National Pediatric HIV Clinic in Gaborone as a physician treating HIV infected children as well as their parents.  I also worked in the National HIV training program, instructing healthcare workers in the surrounding communities.  So why did Ms Garret refer to it as a success story?  And why can’t their results be replicated elsewhere?  Or can they?

Botswana is a moderate sized country located in southern Africa.  It is roughly the size of Texas.  The majority of the country is made up of the Kalahari Desert.  The Okavango Delta, a favorite location for high end safaris, sits in the northwest corner. 

Despite its relatively large size, it is sparsely populated with a population roughly the same as Philadelphia.  This is due to the Delta and the Desert making much of the country nearly uninhabitable.  For the same reason, the population is living almost entirely around the capital city, Gaborone. The rest is located within the remaining 3 large towns – the northern hub of Francistown and the safari launch pads of Maun and Kasane. 

 

Deconstructing Laurie Garrett (Part 4)

Mixing metaphors, Ms. Garrett next explains that fitting programs through the stovepipe doesn't raise all boats.  Of course, in her elegant style and narrative, it makes a lot more sense. 

What she means, I think, is that one of the main problems with un-coordinated donor money comes with limitations, tackling problems of the donor's choosing, and thus the "stovepipe".  So while treating endemic HIV and Tuberculosis may be good, the pressing problems of maternal mortality and childhood respiratory/diarrheal illnesses don't get much attention - even though these are the global leaders mortality causes.  Eventually, Ms. Garrett will argue that, instead of "raising all the boats," the stove-piped money spent on the diseases of donors' choosing will cruelly have a negative impact on overall health in these countries. 

(Best snarky comment: "there's no dysentery lobby".)

(See parts 1, 2, and 3)

Top Ten Doctors (As Seen On TV)

Over 200 real and fictional physicians have been portrayed on American television, evidence of the popularity and success of the medical drama genre.  But only ten have left their indelible mark on how we are viewed as physicians in real life, as played on TV.

10.  Percival “Perry” Cox, MD, Internal Medicine Residency Director, Sacred Heart Hospital

(John C. McGinley) Scrubs-2001-

Anyone who watches this program can tell you how funny it is and how, sometimes, McGinley’s character steals the show from the rest of the players.  Whether he's being insulting and humiliating, or showing small glimpse of compassion and desire to share wisdom - he's the steady compass that keeps the other characters on their comic course.

  9.  Dana Scully, MD, Special Agent, Forensic Pathologist, Federal Bureau of Investigations

(Gillian Anderson) The X-Files-1993-2002

Recruited by the FBI to assist Agent Moulder in his investigations of the paranormal, Scully has, by far the most interesting job of television physicians.  A key character in all but a handful of episodes, she’s best known for her struggle to balances her belief in science and medicine, her religious convictions and her commitment to her partner's questionable practices (motives) - and she knows how to kick ass, too!

8.  Douglas “Doug” Ross, MD, Pediatric Emergency Medicine, County General Hospital

(George Clooney) ER—1994-

Dr. Ross is a character, skilled in caring for children at work, but impossibly unable to care for adults in his life.  In both his professional and private life, we see where his gifts as a physician succeed, along with his failures as a person.  He almost makes the idealized TV doctor more realistic and recognizable to those of us in the profession. But I know why you all watch.  Mr. Stewart…

“If you want my body and you think I'm sexy
Come on, sugar, let me know
If you really need me just reach out and touch me
Come on, honey, tell me so”

[Break – move the dance floor]

Da Da Da Daaaaa Daaaaa

Dada Dada Dada Daaaaa

Dada Dada Dada Daaaa

A Sweet Radio Station

WWOZ in New Orleans is available for live internet streaming.  Give it a chance for some pretty sweet music. 

Deconstructing Laurie Garrett (Part 3)

The article will get to its thesis in a bit.  But now, it's setting up the punch-line, showing that over the past 5, 10 and 20 years, economists have started to "recognize that disease in tropical and desperately poor countries was itself a critical impediment to development and prosperity," and pivoted the tactics of institutions such as the World Bank to health improvement.  Added to President Bush's AIDS initiative and developmental money augmentation, private donors (spearheaded by the Gates and Clintons) and other international organizations (OECD and the Global Fund) have put forth billions of dollars. 

Bottom line - there's a lot more money out there than a decade ago and a lot, lot more than the decade before that.  (Though Jeffrey Sachs still argues that we've not crossed the necessary threshold yet.)

(Parts 1 and 2)

WATER WORKS

Looking out your window seat from a plane over San Francisco Bay, ever wonder what those huge, multicolored sections of water were?  Everyone on the plane has their guess.  "Polluted water" often tops the list, right after "Uh...Iunno".

It’s actually where salt is being made and the color is the reflection of the micro-algae that live in the salt pond waters.  That's right, salt.  The only rocks we people like to eat.  The algae forms the basis of the salt pond ecosystem, that includes brine shrimp, fish, shore and migratory birds of all shapes and sizes.  The salt ponds are a major part of the San Francisco Bay wetlands area.

Learn more about them (and more than you ever wanted to know about salt) from the Cargill company and about the habitat restoration efforts of the South Bay Salt Pond Restoration Project.

http://www.cargill.com/sf_bay/index.htm

http://www.southbayrestoration.org/index.html

Be the smartest person on your flight to and from SFO!

Another public service message brought to you by...

The Ministry of Information

“more power to the misinformed”

Neglected Diseases - Cholera

Alphabetically speaking, Cholera follows Buruli Ulcers on the WHO list of Neglected Diseases.  Most people already know the basics of cholera, a very contagious, oral-fecal transmitted bacteria which causes massive diarrhea (up to 20 liters/person/day) and potential death by dehydration.  For a primer, the WHO's website isn't so bad. 

What's more interesting, however are the recent outbreaks. Here, for example, is a WHO map of outbreaks in Iraq from August to October 2007: 

Ummm...even with the "surge" this was a pretty dangerous time in Iraq.  So does anyone even believe in this map's accuracy?  Why publish this stuff...if and when any scrutiny is done, it'll likely be found to be grossly wrong.