3/1/2007 Inauguration: Doctors offer strategies to cure the world
Two global-health leaders offered a large dose of optimism, along with some grim realities, as they spoke Feb. 27 on ?Strategies to Cure the World.?
Dr. Chris Elias is president of the Seattle-based Program for Appropriate Technology in Health (PATH). The non-profit organization promotes innovative responses to public-health challenges such as HIV-AIDS and tuberculosis.
Dr. Jill Seaman, named one of Time magazine?s ?Heroes of Medicine,? has worked with Doctors without Borders in Africa to battle kala-azar, a deadly disease transmitted by sand flies.
In his talk, Elias posed a question, ?Can we bring health within reach of everyone?? He began with an upbeat assessment: ?We have made unprecedented progress in the last 40 to 50 years,? adding that investments in global health are among the best investments. Urban slums in places such as Nairobi are places of entrepreneurship and opportunity, as well as poverty and violence, he said.
Elias defined global health in terms of life expectancy (77 years in the United States, compared with 34 in Botswana); infant mortality (165 deaths before age 1 per 1,000 births in Afghanistan, six per 1,000 in the U.S.); under-5 mortality; and fertility.
?Global health is our health,? he said, emphasizing medical inequities in an increasingly interconnected world.
Elias described four ?big ideas? for bridging the gap:
? Harness new science and technology of today to reach poor countries. For example, a credit-card-size ?lab? offers rapid, inexpensive diagnostics for people in remote areas with limited access to clinics.
? Develop public-private partnerships. Although development costs make a malaria vaccine unattractive to pharmaceutical companies, 10 potential vaccines are being developed, thanks to innovative financing.
? Use ingenuity from users? perspectives in designing affordable, effective solutions. One global inequity is childbirth-related death: one in 1,333 U.S. cases, one in 17 in Africa. It is most commonly caused by postpartum hemorrhage, easily stanched by a pre-packaged, easy-to-use injection of oxytocin.
? Improve accessibility to available medicines. ?We can have all the innovation we want, but if we can?t get it to people, it doesn?t work,? Elias noted.
He challenged students in the audience to ?become informed citizens and advocates for global health,? adding, ?You don?t have to be a doctor. I don?t think there?s a skill set you?re studying that?s not relevant.?
Returning to his title, Elias said, ?The real question is, how soon can we bring health within reach of everyone?? It takes resources, he acknowledged, ?but mostly, it?s a matter of will.?
Seaman also said political will is needed to develop the tools needed to fight illnesses plaguing poorer nations. Her talk focused mainly on the battle against kala-azar, which has wiped out entire villages in the Sudan. If untreated, most people who contract the disease die of a secondary infection such as pneumonia or malaria. The treatment is injection of heavy metals, Seaman said, noting the irony of using a potentially lethal substance as a cure.
By the time a treatment center opened in 1989, about 50 percent of the Duar area?s population had died, and there had been no schools there for years. Ethnic conflicts have exacerbated access constraints, Seaman said. Her hospital was destroyed twice in militia fighting.
Additionally, the drug proven most effective against kala-azar was discontinued by its manufacturer. The process of getting it reinstated is very expensive, Seaman said.
?It?s difficult to diagnose and treat kala-azar, plus you get other diseases,? she said. ?The real problem is getting the tools to people,? she added. Despite these obstacles, she said, the death rate has declined to 4 percent.