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global health

Nick Harvey: There’s now a cure for hepatitis C… but the poor can’t afford it

15 Apr, 14 | by BMJ

nick_harveyPicture the scenario: a disease is destroying your liver and there’s a chance you will die. There’s a cure, but you can’t have it as it costs more than you earn. There are tens of millions more of people like you. Hundreds of thousands of them die every year.

It sounds like some sci-fi dystopia, but this is the situation that the 150 million people who have hepatitis C virus (HCV) find themselves in today. HCV is spread through blood-to-blood contact, mostly through shared needles. Around 350,000 people die of HCV related liver complaints each year, but new drugs have been developed within the last six months with cure rates higher than 90 per cent. more…

Nathan Sivagananathan and Tehani Renganathan: Trail—improving cancer care in Sri Lanka

2 Apr, 14 | by BMJ

nathan_sivagananathanIn 2011 Nathan Sivagananathan and Sarinda Unamboowe set out to transform the lives of patients with cancer in the northern region of Sri Lanka. For over three decades the northern territory has been in the throes of terrorism, with little room for economic or social development. The ongoing war made the 400 km journey to the country’s only cancer hospital, which was located in Colombo, even more challenging as patients had to travel by both sea and land because of land blocks and danger zones. Many people preferred to remain untreated, unwilling to make the challenging journey across the country to receive the treatment they required. more…

Gavin Yamey: Soldiers, academics, and an unusual health initiative

1 Apr, 14 | by BMJ

gavin_yameyIt’s not every day that you find yourself at a work meeting chatting to a soldier who led the Counterinsurgency Advisory and Assistance Team in Afghanistan and the doctor who directed the largest global health initiative in human history.

Retired US Army Colonel Joseph Felter is now a Stanford University academic with expertise in studying the root causes of political violence. Eric Goosby, an HIV physician at the University of California, San Francisco (UCSF), who was among the first clinicians in San Francisco to treat the disease at the start of the pandemic, led the $US45 billion global AIDS initiative PEPFAR—the US President’s Emergency Plan for AIDS Relief. more…

Simon Chapman: Why is Big Tobacco investing in e-cigarettes?

20 Mar, 14 | by BMJ

simon_chapmanDiscussion about e-cigarettes on social media, the blogosphere, and vaping chatrooms is dominated by impassioned accounts from former, now vaping, smokers wanting to encourage smokers to do what they have done.  The early data on e-cigarettes show them to be as good as, or marginally better than nicotine replacement therapy in helping smokers to stop. Which is sad to say that so far, they are about as unsuccessful as NRT for the great majority who use them. Hopefully, better and stronger data will emerge about newer innovations, but until then, their smoking cessation breakthrough status remains hype. more…

Seye Abimbola and Aku Kwamie: Posting and transfer in the health sector

19 Mar, 14 | by BMJ

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The things we don’t talk about in global health escape our attention perhaps because they don’t have a name—the unnamed subject being, in effect, a non-issue. From 3 to 7 February, a group of 19 researchers, decision-makers, and policy advocates from 12 countries gathered for a meeting at the Rockefeller Foundation Bellagio Centre in Italy to give one such issue a name and place it firmly on the global health agenda. Organised by the Health Governance Hub of the Public Health Foundation of India, and the Averting Maternal Death and Disability programme at the Columbia University Mailman School of Public Health, the meeting deliberated on the problem of posting and transfer of the health workforce (frontline staff and managers), especially in the public sector of low and middle income countries. The importance of posting and transfer cannot be overstated. more…

Richard Smith: NCD among the bottom billion

13 Jan, 14 | by BMJ

Richard SmithMy main job these days means thinking about non-communicable disease (NCD) in low and middle income countries (LMIC), but a paper in the Lancet suggests that I may be thinking in the wrong way. It’s always hard to shift your mental model dramatically, but perhaps I need to do so.

I and the 11 centres in LMIC that I work with are largely following the WHO model, which says that there are four main NCD—cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and some cancers—caused by four risk factors—tobacco, poor diet, physical inactivity, and the harmful use of alcohol. The main approach to these conditions is preventive, through steps like raising the price of tobacco, but also through simple treatments for risk factors like hypertension. The United Nations has ratified this approach, and WHO has set a target of reducing deaths under 70 from NCD by 25% by 2025, the 25 x 25 target. more…

Richard James: Snakes, boats, and muddy tracks—providing healthcare in Myanmar

6 Jan, 14 | by BMJ

richard_jamesI remember thinking that I finally understood what the phrase “hard to reach villages” actually means. After a full dawn-to-dusk boat journey the day before, myself, three Burmese colleagues, two portly government midwives, and the skinny boat owner, pushed off into the narrow river. The wooden boat was the smallest you can imagine seven adults fitting into. One sneeze and I feared we would tumble in.

The river was so narrow I could reach out and touch the foliage. Light green snakes occasionally skimmed its surface. While watching the river banks drift by, I reflected on our collective effort. What struck me most was that this was the exact reverse of the journey a pregnant woman in obstructed labour would have to take. more…

Faheem Ahmed: On the sideline or frontline—where should the British medical profession stand in times of armed conflict overseas?

24 Dec, 13 | by BMJ

faheemOnly days before his proposed release date, Abbas Khan was found dead in a government prison in Damascus. Arrested soon after his arrival in Syria, Dr Khan had initially planned to stay for two weeks in support of the humanitarian relief effort. Instead, he was detained for over a year and was starved, subjugated to physical abuse, and tortured by security forces.[1] Unfortunately, he is now the second British doctor to have been killed in Syria this year after the tragic death of Isa Abdurrahman in June.[2] These two extraordinary individuals had far more in common than London as their birthplace, but a selfless desire to uphold their oath as doctors,” consecrating their lives to the service of humanity.”[3] History illustrates that the ethical dilemma that medics face is not unique, and British doctors have often found themselves, intentionally and unintentionally, in the middle of international wars. This leaves our medical community with two important options: we should either discourage doctors from putting their lives in danger or provide them with more protection and support. more…

Helen M Nwaba on transforming the grassroots response to Nigeria’s HIV/AIDS epidemic

3 Dec, 13 | by BMJ

helen_nwabaWhen a village in North Western Nigeria, which has one of the highest HIV rates in the state, is effectively cut off from other communities and the rest of the country because it lacks a bridge spanning a turbulent river, it took “STAR” power to tackle the problem. That “STAR” is a community led initiative—Society Tackling AIDS through Rights (STAR)—that aims to help remote communities support themselves. The initiative focuses on finding out the priorities of those who often go unheard (especially rural women and girls), and seeking local solutions. more…

Pat Harrold on why Ireland is forging ahead with plain packaging for cigarettes

20 Nov, 13 | by BMJ

pat_harroldWe Irish are good at many things. We are world leaders in literature, music and, occasionally, rugby. Lately we have become famous for tobacco control. Ireland became the first country in the world to ban smoking in public places after some groundbreaking research into the health of Galway bar staff. We are now set to become one of the first countries to ban tobacco branding. This means that the box of twenty will have a plain cover and you can only tell the different types by the lettering. The boxes will look generic, rather like the government products in the old Soviet Union. They will be sombre. more…

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