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global health

Jocalyn Clark: Why has Bangladesh had such success in improving sanitation, but not neighboring India?

23 Sep, 14 | by BMJ

Jocalyn_Clark1Much has been made recently about the appalling rates of open defecation in India, a country that has on other development indicators shown stunning successes. Almost 600 million people in India defecate in fields, forests, bodies of water, or other open spaces rather than in closed latrines or toilets—that’s more than 10 times the number of any other single country, and 60% of the world’s total.

Why, in contrast, does neighboring Bangladesh—a country not only sharing a border but many religious, social, and cultural norms of South Asia—show such sanitation success? more…

Grazia Caleo: Ebola—a blind outbreak

18 Sep, 14 | by BMJ

Grazia-Caleo-Ebola_2In José Saramago’s book Blindness, he describes an epidemic of an unknown infection that causes people to lose their sight. A single person remains uninfected to bear witness to the anger, chaos, violence, and death generated by the spread of disease.

In the novel, humanity’s descent into blindness represents the loss of reason and shows how fear can cause dramatic social breakdown. At the same time, the clear vision of one person represents the opportunity to restore light.

What I saw in Sierra Leone, as an epidemiologist working on Ebola, reminded me of Saramago’s book. more…

Richard Smith: Is global health too medicalised?

16 Sep, 14 | by BMJ

richard_smith_2014When I teach young doctors in Amsterdam about responding to NCD (non-communicable disease) in low and middle income countries, I ask them how they would allocate 100 units of resource. I give them four buckets.

One bucket is for treating people with established disease: patients with heart attacks, strokes, cancer, and chronic obstructive pulmonary disease. The second bucket is for treating metabolic risk factors, such as hypertension, hyperlipidemia, and raised blood glucose. The third bucket is for acting on the four risk factors—tobacco use, poor diet, physical inactivity, and the harmful use of alcohol—recognising that many of the interventions will be political, actions like raising the price of tobacco. The fourth bucket is for working on social determinants, such as poverty, housing, globalisation, and urbanisation. I ask the doctors not only how they will distribute their resources, but what they will do with the resources. more…

Tony Waterston: Wars and peace in Kazakhstan

3 Sep, 14 | by BMJ

“What has International Physicians for the Prevention of Nuclear War (IPPNW) achieved anyway?” The question posed at a workshop on primary prevention needed answering, since the 21st IPPNW Congress meeting we were at coincided with major wars in Gaza, Syria, and Ukraine. Not even the most ardent members of IPPNW would expect our organisation to prevent all war, but we did get the Nobel peace prize in 1985 for warning the world about nuclear war.

And Nobel peace prize winner Mikhail Gorbachev, in his memoirs, said: “It is impossible to ignore what these people are saying. What they are doing commands great respect. For what they say and what they do is prompted by accurate knowledge and a passionate desire to warn humanity about the danger looming over it.” more…

Lavanya Malhotra: The ice bucket challenge—trivialising trend or canny awareness campaign?

28 Aug, 14 | by BMJ

Lavanya MalhotraLately, social media sites have been invaded by videos of people upending buckets of icy water over their heads. The goal behind this watery exercise is to raise funds, as well as awareness, for amyotrophic lateral sclerosis (ALS) research. The ALS ice bucket challenge is simple: douse yourself in icy water, record it, post it online—on Facebook or Twitter, for instance—including a message about doing it for ALS research, and donate money to the ALS Association (ALSA) through its donation webpage. In the UK, people can donate to the Motor Neurone Disease Association.

The final step is to nominate several friends to do the same. This chain reaction strategy has generated publicity and money for ALSA. So far, 1.7 million people have donated, raising $79.7m (€60.4m; £48m). more…

Jasmin Islam: Ebola readiness—lessons from a district general hospital

26 Aug, 14 | by BMJ

Since the Ebola outbreak was confirmed back in March 2014, I, like many doctors, have been following its progress with a great deal of interest and sadness over the increasing number of deaths, which have included several healthcare workers. In relation to the current outbreak, there have been no confirmed cases of Ebola in the UK and, given increased surveillance and awareness, the risk of importing a case remain low. However, all hospitals should be prepared. more…

Aser Garcia Rada and Laura Reques Sastre: Fever after a trip to the Caribbean? Think of chikungunya

18 Aug, 14 | by BMJ

Aser García Rada_BMJIn Spain we are beginning to attend to a growing number of suspected cases of chikungunya—a disease most of us have never faced before—among patients coming from the Caribbean region. Chikungunya (a Makonde word for “that which bends up”) is a viral disease transmitted by mosquitoes of the Aedes Aegypti and Aedes Albopictus (tiger mosquito) variety. The disease causes fever and severe joint pain for several days. It is usually self-limiting, but it can cause severe chronic ocular, neurological, cardiac, or gastrointestinal complications. more…

Sarah Woznick: A nurse’s account of working in Gaza

21 Jul, 14 | by BMJ

msf_gazaSarah Woznick is a specialist intensive care nurse working with Médecins Sans Frontières (MSF/ Doctors Without Borders). She arrived in Gaza six months ago from Denver, Colorado. She was due to leave the mission the day after operation “Protective Edge” began, but decided to stay on to help provide medical care.

Image: Sarah in the intensive care unit of Nasser hospital, Gaza. Credit: MSF. 

I was scheduled to leave Gaza the day after the military operation “Protective Edge” started. That first day there were lots of air strikes in our area. It’s a strange feeling when you realise that one is falling not far from you. Now I am a little more accustomed, but it still makes me jump from time to time. All of us think about our Palestinian colleagues. The MSF compound is a safe place, but their homes might not be, and we worry about them and their families. more…

Ike Anya: What can mobile phone polling tell us about population health?

18 Jul, 14 | by BMJ

Ike_Anya-2014One Friday afternoon in May, I sat in my local library in London, surrounded by young men and women, who looked mostly like students studying for examinations. As they buried their heads in their books or scanned their laptop screens, I furiously tapped at the screen on my phone, causing a few heads to look up at me.

My fervid activity was in the cause of answering questions from people in Nigeria about cardiovascular disease and the risk factors associated with it. My tapping was part of #PollingFriday, a weekly Twitter chat that is organised by Nigeria’s first polling organisation, NOIPolls, to publicise the results of their latest polls. Through Twitter, members of the public are encouraged to ask questions about the polling topic, and an expert on said topic is invited to answer their questions. more…

Gitau Mburu: Why communities should care about WHO’s antiretroviral guidelines

16 Jul, 14 | by BMJ

gitau_mburu2014A year ago, the World Health Organization (WHO) issued revised and consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. These guidelines included a key recommendation to initiate HIV treatment earlier (at 500 CD4 cells/mm³ or less) in order to ensure that people with HIV live longer, healthier lives, and to substantially reduce the risk of HIV transmission. If implemented globally, earlier HIV treatment could avert an additional 3m deaths, and prevent 3.5m new HIV infections by 2025.

Getting people on to treatment earlier is now a moral and scientific necessity. However, we know that many communities around the world are already facing tremendous challenges in accessing HIV services. Therefore, reaching a greater number of people who will need treatment even earlier is going to be complex, and will require wholehearted buy in and engagement from affected populations. more…

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