Civil Unrest and Communicable Disease Control

The current issue of Lancet Infectious Disease has a news story on the continuing neglect of visceral leishmaniasis.

The author makes the point that war and civil unrest are major impediments to control of endemic communicable disease. This article uses the example of the political situation in Sudan hampering programs for treatment of leishmaniasis.

This is only one example of many, of course. Regional elimination of disease is impossible if even one country in an endemic area has an ineffective government program. An even better example is the onchocerciasis control program (OCP) in West Africa. The OCP was a major effort to eliminate onchoceriasis in West Africa in the 1970s-1990s. In many countries the OCP worked to control onchocerciasis and prevent river blindiness. However, despite international investment, aggressive vector control, and coordinated government/NGO treatment programs, the OCP failed to eliminate onchocerciasis from West Africa primarily due to the decades of conflict in Sierra Leone.

Heat Wave Hits Bihar

We did not think life in Bihar could get harder, but our local staff assure us that it can. From the Patna Daily Today:

The current heat wave gripping much of the state forced most people to stay indoor on Monday as temperature soared to 42° Celsius (108° Fahrenheit), at least 5° more than the average around this time.

Those who were forced to step outside their homes were seen covering their faces with scarves and towels while making frequent pit stops at roadside vendors to grab a cold glass of sugarcane juice, watermelons, or 'sattu' drink to quench their thirst.

I like the rickshaw driver in the background of this pic. Can you imagine driving a bicycle rickshaw in 108 degree heat?

Something "More Personal"

The people at El Periodico asked me for something "more personal" for the kala-azar blog. I am not sure what they want, but this is what I sent them:

In this entry, I describe a typical day as a field doctor in India. I hope this helps convey what it is like to work as a doctor in with MSF in Bihar.

7:00 am- I wake up to the noise of my ceiling fan. The fan functions more as a noise-making machine than a cooling device. It also turns the room into a dust storm. The mosquito net over my bed started out white, but now it is a dark shade of grey. I take a cold shower. As soon as I dress, I start to sweat.

7:30 am- While I am eating breakfast, Sara--the field nurse-- comes into the room. She is doubled over in pain. She says that she started getting diarrhea and abdominal pain at 11pm last night. She looks terrible. I am responsible for the medical care of all expat field staff. I advise her to drink a lot of water mixed with oral rehydration solution and to hold off on taking any antibiotics. She tells me that she has already started herself on antibiotics. I advise her to rest all day in bed. She tells me that the medical order is due in the capital today, and that plans to work on it whether she is sick or not.

8:00 am—I walk down four flights of stairs and arrive at our office, which is located on the ground floor of our apartment building. I rejoice that the internet connection is working again. I check my personal email account. There are six SPAM messages, two or three work-related messages, and no personal messages from friends or family. I feel depressed.

8:15 am- I have almost two hours to work on administrative issues before I need to leave for the hospital. I review the medical coordinator’s report on his recent visit to the field. I write a memo to the project epidemiologist and medical coordinator about reorganizing our follow-up visit system. I make a list of essential medical books for our project library. I work on the national doctors’ rotation schedule for Sept-Dec 2009.

10:15- I arrive in the hospital for ward rounds. We round as a team of 4 nurses, 3 doctors, and a ward attendant today. The ward is almost full; there are about 40 patients inside, and ten patients on cots in the hallway. I feel bad for the patients outside; it is 40 degrees C and they are covered in flies. There are many complicated cases. Some patients may have typhoid that we have misdiagnosed as kala-azar. We suspect many patients are coinfected with tuberculosis. There are a couple patients who I think have neither kala-azar, enteric fever, HIV, or tuberculosis, but they are spiking fevers and look sick.


3:00pm- National staff nurses, doctors, health educators, and logisticians gather in the office for a brainstorming meeting on how we can improve our activities in the rural facilities. There is active participation in the conversation. Several good ideas are discussed, clarifying our priorities for the next 18 months of the project. Marlies—the project field coordinator—and I agree that the meeting has been productive.

6:30 pm—My commute from office to home takes less than a minute. I want to exercise, but it is impossible to do anything outside. Rafa and Marlies are doing yoga in the room where I often jump rope in the evening.

7:30 pm—I am having trouble getting work-related thoughts out of my head. I feel trapped inside the house. We are not allowed to walk outside the house alone in the evening or drive the car. When yogis are finished, Marlies and I convince Rafa to turn on the generator for three hours so we can watch a DVD.

10:30pm-- By the end of the movie I feel more relaxed. It has cooled down enough to make sleep a possibility.

El Periódico

El Periódico--a Spanish newspaper-- is publishing a filtered and distilled version of this blog. I wrote it to help publicise MSF´s work on the neglected tropical diseases. Here´s the link. It´s in spanish (translated by MSF-communications in Barcelona).

Obama on Community Service and MSF

Obama gave press conference/town hall meeting in Strasbourg on April 3rd. I like what he said about community service. And he mentioned MSF! Thanks dad, for telling me about the speech.

Question: wanted to know if you -- did you ever regret to have run for presidency till now? I mean, well, did you ever ask yourself, am I sure to manage -- yes.

PRESIDENT OBAMA: Yes, it's a good question. (Applause.) Michelle definitely asked that question. (Laughter.) You know, there are -- there have been times, certainly, during the campaign, and there have been times over the last several months where you feel a lot of weight on your shoulders. There's no doubt about it.

During the campaign, the biggest sacrifice -- the thing that was most difficult was that I was away from my family all the time....You also lose privacy and autonomy -- or anonymity. You know, it's very frustrating now -- it used to be when I came to Europe, that I could just wander down to a café and sit and have some wine and watch people go by, and go into a little shop, and watch the sun go down. Now I'm in hotel rooms all the time and I have security around me all the time. And so just -- you know, losing that ability to just take a walk, that is something that is frustrating.

But having said all that, I truly believe that there's nothing more noble than public service. Now, that doesn't mean that you have to run for President. (Applause.) You know, you might work for Doctors Without Borders, or you might volunteer for an -- or you might be somebody working for the United Nations, or you might be the mayor of Strasbourg. Right? (Applause.) I mean, they're all -- you might volunteer in your own community.

But the point is that what I found at a very young age was that if you only think about yourself -- how much money can I make, what can I buy, how nice is my house, what kind of fancy car do I have -- that over the long term I think you get bored. (Applause.)

I think your life becomes -- I think if you're only thinking about yourself, your life becomes diminished; and that the way to live a full life is to think about, what can I do for others? How can I be a part of this larger project of making a better world?

Now, that could be something as simple as making -- as the joy of taking care of your family and watching your children grow and succeed. But I think especially for the young people here, I hope you also consider other ways that you can serve, because the world has so many challenges right now, there's so many opportunities to make a difference, and it would be a tragedy if all of you who are so talented and energetic, if you let that go to waste; if you just stood back and watched the world pass you by.

Better to jump in, get involved. And it does mean that sometimes you'll get criticized and sometimes you'll fail and sometimes you'll be disappointed, but you'll have a great adventure, and at the end of your life hopefully you'll be able to look back and say, I made a difference. All right.Thank you, everybody.