Today’s HIV Focus And Concern

June 14th, 2019 by INMED
Posted in International Public Health|

In 2017 (the latest data available)…

 

  • 36.9 million people globally were living with HIV
  • 1.8 million were children (<15 years)
  • 75 percent of HIV-positive people knew their HIV status
  • 21.7 million people were accessing ART
  • 1.8 million people became newly infected with HIV in 2017
  • 940,000 people died from AIDS-related illnesses
  • TB remains the leading cause of death among HIV-positive people

 

Worldwide, the incidence of new HIV infection has declined 18 percent since 2010. But the HIV epidemic continues to be a serious threat. Incidence is increasing in North Africa, Eastern Europe and Central Asia. And in sub-Saharan Africa, women and adolescent girls are especially vulnerable. 1,000 become infected every day.

 

Even more concerning is that in the face of growing complacency, social stigma, decreased government interest, and reduced funding for research and treatment, experts are warning of a resurgence of AIDS. The virus still a public health danger, especially in hard to reach communities and among people who are at greatest risk.

HIV And Good News!

June 7th, 2019 by INMED
Posted in International Public Health|

This is not a frequently heard phrase. But it’s true. Control of HIV has progressed remarkably since the year 2000. Some highlights include:

 

1996: Combination AntiRetroviral Treatment (ART) is found effective in HIV treatment

1997: AIDS deaths begin to decline in nations that offer ART

2002: The Global Fund is founded to combat HIV, TB and malaria

2003: ART cost diminishes and becomes more available in developing nations

2010: Pre-exposure prophylaxis (PrEP) is found to reduce HIV transmission

2013: UNAIDS reports that AIDS-related deaths have fallen 30% since their peak

2015: WHO launches new treatment guidelines that that all HIV-positive people should receive ART, regardless of their CD4 count, and as soon as possible

2017: For the first time, more than half the global HIV-positive population are receiving ART, a record of 19.5 million people

 

For all the angst associated with HIV, and all the recent advances in its control, we are justified in enjoying a moment to celebrate HIV and good news!

Could You Get Measles and What Would it Do to You?

May 31st, 2019 by INMED
Posted in International Public Health|

Out of sight, out of mind. Regardless of the phenomenon, it’s a fact of human psyche. Measles was eliminated in the United States in 2000. Then, complacency and skepticism set it – call it out-of-sightness – and through May 1 of this year 704 measles cases have occurred. Americans are not alone. The Philippines in 2019, for example, has so far reported 33,000 cases and 466 deaths.

 

Could you get measles? It is highly contagious. An unvaccinated person sharing a room for just five minutes with someone suffering from measles has a 90% chance of becoming ill. Debilitating fever and rash are most common, and measles can also progress to pneumonia and brain infection. Could you get measles if you’re vaccinated? Not likely. Just one dose is about 93% effective. Two doses are about 97% effective at preventing measles.

 

What are the risks of measles vaccine itself? Common side effects include fever, mild rash, and swelling of glands in the cheeks or neck. MMR vaccine has been linked with a very small risk of febrile seizures, about 4 for every 10,000 children immunized, and no long-term effects. Objective, independent research affirms that MMR vaccine is not linked with risk of autism.

 

Let us not abandon hope for the human psyche. The worse outcome from out-of-sightness is allow its progress toward actions of out-of-mindness that put we and our children at risk.

Anti-Poverty Vaccine? Is That Possible?

May 24th, 2019 by INMED
Posted in Low-Resource Healthcare Pearls|

Introducing Peter Hotez, my friend and today’s best known proponent of anti-poverty vaccines. Peter is an accomplished scientist and pediatric infectious disease specialist at Texas Children’s Hospital. A tactful, vocal proponent for policy and civic action on multiple health fronts, one of his most intriguing campaigns is to combat poverty through vaccination.

 

The associations between poverty and ill health are legion. A pregnant women with hookworm infestation, for example, is likely anemic, malnourished, and fatigues easily. Her ability to earn a living, care for herself, or care for her family is usually impaired. Hence, her poverty increases.

 

Our world’s poorest citizens are plagued by a number of parallel infectious diseases that limit their income-earning potential: schistosomiasis, African trypanosomiasis (sleeping sickness), or American trypanosomiasis (Chagas disease), malaria, tuberculosis, among others. Vaccine development against these poverty-inducing maladies hold promising potential., but has been generally slow and under-funded. And yet – as proven in the case of smallpox – such effective vaccines may not only prevent disease, but also prevent poverty.

Life’s Most Dangerous Day

May 17th, 2019 by INMED
Posted in International Public Health|

What has been the most dangerous day in your life? The first time you drove a car solo? Or maybe a particular football or hockey game? Population research demonstrates that younger age is highly correlated with risk of death. Most child deaths are infant deaths. Most infant deaths are neonatal deaths. Most neonatal deaths occur in the first week of life and most deaths in the first week occur on the day of birth. The day of birth is a uniquely vulnerable time, and one’s birthday is the most dangerous day of life.

 

This danger is especially great where poverty, inequality and societal unrest undermine maternal and newborn care. Poor maternal diet, inadequate housing, and lack of sanitation compound the dangers. Worse yet, complex humanitarian emergencies catalyze dramatic movements of people, including pregnant women and newborns, and compromise access to functional health systems. Low education levels, gender discrimination, and a lack of empowerment prevent women from seeking health care.

 

Reducing the danger from Day Number One requires not simply professional health services, but broad social interventions that address poverty, inequality and societal unrest. Responsibility for action must be equally broad. William Foege, an American epidemiologist credited with devising the global strategy that led to the eradication of smallpox in the late 1970s, makes this point quite powerfully: “Child mortality is a measure of civilization … not just for countries with high child mortality, but also for countries that could have changed the situation.”


East vs. West: Chinese Learn, Serve and More

May 10th, 2019 by INMED
Posted in Healthcare Education|

INMED today is teaching 40 of the brightest, most motivated learners we’ve ever engaged – and they all live in China. Representing every Chinese province, these healthcare personnel were recommended to us as exceptional. Yesterday I assessed their first Professional Certificate Course in International Medicine & Public Health assignments, projects and exams. Everything their superiors claimed proved true. These are indeed remarkably responsible, effective learners. But we would not be satisfied to simply inflate one’s knowledge and credentials alone. What does their professional progress and expertise mean for low-income or otherwise disadvantaged Chinese persons?

 

Approximately half of INMED’s Professional Certificate Course graduates proceed into a supervised, service-learning experience at a Training Site where care is top priority for those who are disabled, elderly, poor, or minorities. Some of our Chinese graduates complete their service-learning within the country at locations like H’Image Doctor. Others like Edgar Wu serve in more difficult countries like Cambodia and Lebanon, too. All in all, this is a beautiful sight, those most bright bringing hope amid life’s blight.

Larissa Penner: After God in Haiti

May 3rd, 2019 by INMED
Posted in INMED Grads In Action|

Larissa Penner: seriously enthusiastic about serving forgotten people. An RN from Nova Scotia and to the left in this photo, I met Larissa at the 2018 Glendale CA Professional Certificate Course in International Nursing & Public Health. Weeks later, she was on location in Jérémie, Haiti, to begin a two-year service stent. Larissa is socially graceful, constantly smiling, and herein shares her experiences…

 

“We’ve had several other babies this month with severe respiratory distress. A 2-year old had a respiratory rate of 100, and there were more kids with O2 sats of 60%. I love how quickly kids get better; their O2 sats quickly jump to the 90s with a few litres of O2, though our O2 machine only goes up to 5 litres.

“Had a lady come in that had had a baby the day previous and had ‘something hanging out.’ It was a rotten piece of placenta. Gave her some oxytocin and her placenta delivered! No bleeding, and her uterus was nice and hard. Covered her with antibiotics, too.

 

“Pulled out of church for an emergency, a pregnant lady whose husband had stood on her, beaten her, and then left. She was 16 weeks pregnant, complaining of bleeding and abdominal pain and moaning, and unable to ambulate. Everything on assessment was fine except a massive urinary tract infection. We gave an antibiotic, recommended an ultrasound, and sent her home with a safe family. As they were leaving, we heard them say, ‘Nurses are after God. She couldn’t even walk before we came.’”

 

Larissa Penner: skilled, after God, and another INMED Graduate who continues seriously enthusiastic about serving forgotten people.

1st Malaria Vaccine – Bold Advance for Humanity

April 26th, 2019 by INMED
Posted in Global Health News & Inspiration|

David Livingston died of malaria. So did celebrated individuals like Oliver Cromwell and Vasco de Gama. Today some one million children and pregnant mothers each year succumb to malaria. Personally, I’ve treated hundreds of malaria patients in Angola, and at least twice suffered from malaria myself.

 

As a tropical medicine student at Walter Reed Army Institute of Research, I was personally invested in their diligent efforts to develop an effective vaccine. Diligence has now born fruit in the release of RTS,S – the first malaria vaccine that shows protection in large scale clinical research studies. RTS,S is being administered to 360,000 children: first in Malawi, and then in Kenya and Ghana – regions where malaria is particularly lethal.

 

RTS,S is not an ideal vaccine. It protects 40% of those vaccinated, and that protection wanes after only 18 months. But as illustrated in the above graphic, administration to large populations over a period of years is mathematically predicted to curb malaria mortality. In this anticipation, we celebrate today with all of humanity!

Why Do Mothers Continue To Die?

April 19th, 2019 by INMED
Posted in Low-Resource Healthcare Pearls|

Tragedy aptly describes the emotions surrounding the death of a pregnant woman. Until recently, grave markers in the United States frequently stated “died in childbirth.” And while such deaths have greatly diminished in North America, they remain frequent in the lower resource nations. Haitian women, for example, have a saying “I am going to sea to catch a new baby, but the journey is long and dangerous, and I may not return.”

 

What is the most common cause of postpartum hemorrhage, that is, bleeding following delivery? Failure of the uterus to contract normally causes bleeding to continue. This atony is the leading cause of postpartum hemorrhage, and this risk is one of the reasons why deliveries should always take place in the facility with immediate access to life-saving intervention. Unfortunately, in many nations well equipped birthing centers are accessible only by wealthy persons.

 

But an even more common clause of maternal death is the category of “Other Causes.” What are these? Malaria is particularly lethal towards pregnant women. Chronic diseases like asthma and valvular heart disease caused by dramatic fever are also among the frequent other causes of maternal mortality.

 

What is the implication of these facts? Most maternal deaths occur at the time of labor and delivery. Our advocacy for development of skilled birthing centers, such as the work of the Global Birthing Home Foundation and Save The Mothers, is particularly strategic to curb maternal tragedy.

Herd Immunity Is For Humans, Too

April 12th, 2019 by INMED
Posted in International Public Health|

Amid the startling rise in measles cases it is imperative to draw upon a basic tenant of public health: herd immunity. This is the relative protection provided to unvaccinated individuals by being surrounded by those who are vaccinated, and hence less likely to transmit infectious agents to the unvaccinated one.

 

In the above scenario on the far left, the person in red color who is ill from measles (or another contagious disease) is surrounded by few vaccinated persons in blue color. Thus, moving next image to the right, this one unvaccinated person can rapidly disseminate the disease, and soon all the blue, unvaccinated persons become red and ill.

 

By contrast, in the right-side scenario, the ill person in red color is surrounded by many vaccinated persons in yellow color, thus protecting those persons who are unvaccinated in blue color.

 

One important implication of heard immunity is the imperative that everyone be vaccinated, and that no one simply assume that the vaccinated persons surrounding them will provide protection. For herd immunity to be effective, everyone must be part of the herd.