Inflammation and stories on medicine

tourism in Thailand
Thailand is a unique country that attracts over 32 million tourists each year. Tourism made up 20.6 percent of Thailand’s GDP in 2016 and supported about 6.1 percent of jobs. Bangkok, Thailand’s capital, was the most visited city in 2017. It is clear the tourism in Thailand is impacting the country.

Thailand’s 2004 Tsunami Recovery

Tourism both aided and hindered Thailand in its post-tsunami state. With a high need for jobs and funds, many luxury hotels were able to reopen within months. Unfortunately, some groups such as migrant workers had a difficult time receiving aid, if they even received any at all.

The event was also a catalyst for the marginalization of those in a lower socioeconomic status as many were barred from returning to their homes in popular tourist areas such as the beach. It is estimated that upwards of 10,000 were either prevented from returning or an attempt was made to prevent them from returning.

The Marginalized in Thailand

The country’s social bias against migrant workers, immigrants and refugees is one of Thailand’s biggest criticisms. People in these marginalized groups are at a legal disadvantage compared to Thai citizens. Migrant workers are at the will of their employer, needing a “termination and employer transfer form” (in other words, permission from their current employer) in order to switch jobs. Research by the International Labor Organization (ILO) in 2010 found 33 to 50 percent of employers in the fishing, domestic and manufacturing sector used this law to their advantage to prevent losing migrant workers as employees.

There are also multiple reports of migrant workers being punished by law in what seem like uncertain situations. One example is the fourteen migrant workers who filed a complaint against their employer for exploitation, thus damaging the company’s reputation. This resulted in the employer filing a lawsuit against the workers with potential consequences being imprisonment and fines. 

Another unfortunate example occurred in 2015 when two migrant workers from Myanmar were sentenced to death for the murder of two tourists; the case was marred by police misconduct such as the mishandling of evidence and the alleged torture of the workers. While it is difficult to find an exact number of migrant workers convicted of a crime in Thailand, it is becoming increasingly clear to the world that this is a human rights issue that needs to be addressed.

Sex Tourism in Thailand

Prostitution was outlawed in the 1960s, but Thailand still has a growing trade revolving around paid sex. There is no way to get a real number on those traveling for sex tourism in Thailand, but NGOs estimated 70 percent of male travelers were visiting specifically for the sex industry in 2013. Prostitution does not have a social stigma in Thailand like in other countries and many Thais have accepted it as part of the culture, creating growth in the industry despite questionable legalities.

Medical Tourism in Thailand

Many tourists travel to Thailand because of the low-cost medical treatment. In 2006, about 200,000 tourists traveled to Thailand explicitly for medical treatment. By 2011, that number rose to half a million.

According to insurance company Thai Expat Club, Thailand was third in the world as the most likely destination for health tourism in 2016. Many medical tourists are saving at least half of what they would pay in the US. Add on recovery by the beach or in a resort and it is no wonder Thailand has become the medical hub of Asia.

Tourism’s Impact on the Environment

With tourism in Thailand increasing, trash increases as well. Unfortunately, Thailand’s infrastructure has been unable to keep up. A common assessment has been waste left over from beach parties. It is estimated that Ko Phangan Full Moon beach parties leave about 12 tons of debris per day behind which mostly goes into landfills or the ocean.

Many groups are currently trying to highlight this issue which will hopefully create a springboard for biodegradable materials and other environmentally conscious decisions. Some of the organizations partnering with Thailand to address the waste issues are the U.S. Environmental Protection Agency, which collaborates with Thailand to protect environmental laws, and the International Union for Conservation of Nature, which works on conservation within the country.

Tourism in Thailand is drawing in great opportunities such as growing jobs, a developing medical field and cultural awareness. However, there are some points of contention with prostitution, the waste problem and an increasing awareness of the marginalized in Thai society. Curbing environmental problems and working toward a more equal society will create a stronger Thailand and, ultimately, a stronger world.

– Natasha Komen
Photo: Flickr

medical advancements in Ethiopia
With a population of approximately 106 million, the nation of Ethiopia is the second most populous country in Africa. Along with this large population, Ethiopia also has one of the highest poverty levels in the world and is one of the most underdeveloped countries on the continent.

Due to this underdevelopment, Ethiopia has many medical and healthcare related concerns that have historically not been able to be addressed. Recently, the government of Ethiopia has made the health of its citizens a priority, leading to many medical advancements in Ethiopia.

The current health system in the African nation is unable to provide for over half of its large population. One of the main reasons that Ethiopia has been unable to provide medical care to so much of its citizens is because there are not enough medical facilities in the country, and many people do not have access to the ones that do exist.

According to the World Health Organization, only 75 percent of urban families and about 42 percent of rural households are within walking distance from a hospital. When individuals are able to access a medical facility, they are often met with facilities that are understaffed, have workers with low qualifications and do not have many standard clinical supplies.

One of the ways that medical advancements in Ethiopia are occurring is by working on improving this shortage of medical facilities. An example is the expansion of St. Paul’s hospital in Ethiopia’s capital, Addis Ababa. Though this is an existing medical facility, the expansion will help the hospital take in more citizens than it has previously been able to. Currently, the hospital has between 12 and 14 beds in the emergency room; after the expansion is complete, the emergency room will hold up to 50 beds. This expansion is partially possible because of the partnership between Millennium Medical College in Ethiopia’s capital and the University of Michigan.

Another way in which medical advancements in Ethiopia are being made is by the nation’s dedication to treating HIV and AIDS. With the help of the United States, the Ethiopian government has committed to providing free treatments for HIV and AIDS. U.S. aid has been a vital part of this effort and has been working to provide the needed treatments. According to USAID, in just one year the number of Ethiopians accessing HIV counseling and testing increased from 500,000 to more than nine million. It is also reported that the number of people on anti-retroviral therapy increased from 900 in 2005 to 394,000 in 2015.

This expansion of current medical facilities and commitment to the treatment of HIV and AIDS are just two ways in which medical advancements in Ethiopia are being made. The University of Michigan has said that Ethiopia is experiencing a “medical revolution,” and it appears that this is just the beginning.

– Nicole Stout

Photo: Flickr

Medical humanitarian aidAccording to the Center for Disease Control and Prevention (CDC), an epidemic is a significant and sudden increase in the number of cases of a particular disease in a specific area or within a certain population. Epidemics can present themselves all over the world. However, epidemics are most common in impoverished, war-torn and developing countries.

Medical humanitarian aid can help end epidemics in many impoverished countries. Most countries that receive foreign humanitarian aid are not properly equipped to deal with disease outbreaks, nor do they have the trained medical professionals needed. This is how a disease outbreak quickly turns into an epidemic.

Many international medical relief groups focus their efforts on controlling epidemics by providing adequate medical training, professionals and equipment. Listed below are some of the international medical relief groups that are working toward ending epidemics.

Medical Teams International

Medical Teams International is a Christian-based international relief group that has been using medical humanitarian aid to help end epidemics. The group works by delivering medical supplies and trained volunteers to areas in need. The mission of the group is to provide medical, dental, humanitarian and holistic relief to diverse areas without discrimination.

For over 25 years, Medical Teams International has been providing relief for refugees in impoverished and war-torn countries. For example, in 2017 the United Nations declared a famine in South Sudan as a result of the civil war that has been ongoing since 2013. Shortly after the declaration, Medical Teams International dispatched massive relief efforts to combat the Cholera and Malaria epidemics.

Currently, Medical Teams International has provided medical humanitarian aid to over 520 thousand Sudanese refugees, severely curving the disease epidemics in that area.

Médecins Sans Frontières (MSF)

Medecins Sans Frontieres, also known as Doctors Without Borders, is one of the most well known international medical-based relief groups in the world. For over 45 years, the group has dispersed trained medical professionals and medical humanitarian aid across the globe. Medecins Sans Frontieres is also on the cusp of many medical initiatives in impoverished countries.

Medecins Sans Frontieres is known for tackling large disease outbreaks and epidemics in poor and dangerous areas. In 2017, Medecins Sans Frontieres dispatched relief efforts to Uganda after the country was declared in a state of humanitarian emergency. The group focused its efforts on the recent Cholera outbreak spreading through Uganda, setting up multiple Cholera clinics to help treat and prevent the spread of Cholera to other refugees in Uganda.

Direct Relief

Direct Relief is another nonprofit humanitarian aid organization that primarily focuses on medical relief to devastated areas. The goal of the organization is to provide proper and comprehensive medical aid for impoverished areas and emergencies. In 2017, Forbes ranked Direct Relief among the top United States charities.

Over the past five years, Direct Relief has provided medical humanitarian aid to over 80 countries, many in Africa and South Asia. They have supplied over two thousand healthcare facilities and have sent billions of U.S. dollars worth of medical equipment and supplies.

These international organizations and many more have worked hard to make medical humanitarian aid more accessible to impoverished countries. Many epidemics that have started due to unsafe food, unsafe water and a generally poor environment have been contained and even eliminated by medical humanitarian aid. These organizations believe that with the right aid and volunteers, diseases around the world can be eradicated.

– Courtney Wallace

Photo: Flickr


Healthcare programs often dismiss the importance of pediatric surgery in the developing world. Access to surgeons is treated as a superfluous medical resource rather than a necessity and therefore becomes extremely limited. The only pediatric surgeons in Kenya are located in Nairobi, making them difficult for most Kenyans to visit. In actuality, the demand for surgery among children in developing nations is strikingly high and the shortage of surgical care has extremely detrimental consequences.

In sub-Saharan health clinics, up to 11 percent of all child patients are in need of surgery. Of these children requiring surgery, nearly 90 percent are admitted with issues easily corrected by surgery such as congenital anomalies and injuries. Unfortunately, many children cannot obtain the surgical care they need. Even in urban communities with more convenient access to healthcare, approximately 217 out of 100,000 people die due to injuries, which could be corrected via surgery. By the age of 15, there is an 85 percent chance that children in Sub-Saharan Africa will experience a condition requiring surgery; without surgical attention, children can develop lifelong disabilities.

In impoverished countries that experience war and conflict, the chance of childhood injury is even higher. Children are often injured by stray bullets and explosives, and are even sometimes coerced into fighting. The Central African Republic experienced many child casualties during its most recent conflict (2012-2014), which put significant strain on its subpar healthcare system.

Even prior to the conflict, the Central African Republic had the sixth highest mortality rate of children under the age of five. Bangui Pediatric Hospital was overwhelmed by the influx of child patients during the war, but the U.N. supplied surgical kits and other medical supplies to temporarily rectify the void of surgical care.

Many other aid organizations are working to make pediatric surgical care more accessible in the developing world. The Global Pediatric Surgery Network has volunteer surgeons at work in various parts of the world, including Tanzania, Uganda, Ethiopia, India, Pakistan, Cambodia and Vietnam. The Pacific Association of Pediatric Surgeons teaches surgical skills to general practitioners in impoverished countries in order to create more permanent solutions to the inadequacy of pediatric surgery in the developing world.

The most common issues faced by volunteer pediatric surgeons in developing countries are financial constraints, inadequate healthcare facilities, insufficient infrastructure and geographically isolated populations. Fixing these problems is tantamount to improving surgical care for children in the developing world. Correcting surgical conditions in childhood increases a person’s quality of life, which strongly illustrates how surgery is such a necessary component of a complete healthcare system.

– Mary Efird

Photo: Flickr

Counterfeit Medicine in AfricaThe global counterfeit medicine market is enormous, making up an estimated 10 percent of medicines sold globally. It is especially prominent in developing nations, in which up to 30 percent of all medications are found to be counterfeit or substandard. In Africa, this means that 120,000 people per year die from counterfeit anti-malarial drugs alone. Such is relatively unsurprising, when considering that an estimated one third of anti-malarial drugs in Sub-Saharan Africa are thought to be counterfeit.

One of the primary issues in tackling this issue of counterfeit medicine in Africa is a lack of public awareness; many individuals simply do not know they risk purchasing counterfeit or substandard medicine. Those entrenched in the cycle of poverty are most often the victims of counterfeit medicine, as they typically have a smaller variety of medicinal options available to purchase- meaning that they might unknowingly have no choice but to purchase a counterfeit drug. Further, the poor generally opt for cheaper medicines, unaware that such medicines are often counterfeit. This lack of variety and financial accessibility ensures that the counterfeit medicine market preys on the poor in particular.

In the effort to address the issue of counterfeit medicines, Nigeria has emerged as a world leader. The nation’s strategy focuses on three areas: public education regarding counterfeit medicines, increased regulation for medicinal imports to stem the flow of counterfeit medicines and reinforced points of entry to mitigate the smuggling of counterfeit medicines. Since it first began this strategy in 2001, Nigeria has successfully reduced the incidence of these drugs by 90 percent, clearly demonstrating that the issue can be successfully minimized through intentional actions.

Nigeria’s stance as the leader in the battle against counterfeit medicine made it the logical base for Sproxil – a company that has created a mobile phone-based technology to verify the authenticity of purchased medicines. Medicinal companies can register their products with Sproxil, receiving individualized scratch-codes to be placed on their products. Once the product reaches a consumer, the consumer scratches off the code and texts it to Sproxil, who then verifies the code in its database. If the code is not verified, the consumer is immediately alerted and given a number to report it. Considering the widespread use of technologies such as MobileMoney in Africa, the structure of Sproxil is ingenious and entirely conducive to the lifestyle of the average consumer.

To date, Sproxil has provided over five million anti-counterfeit labels, contributing to Nigeria’s strategy of public education regarding counterfeit medicines. The company seeks to expand beyond Nigeria, into Kenya and India next. The effectiveness of simple education and verification techniques in Nigeria serve as a wonderful example of successful strategies against counterfeit medicine in Africa, and also the world on the whole. If other developing nations are able to adopt a similar education and verification-based strategy to combat the counterfeit medicine market, the future is bright, indeed, for the increased mitigation of the issue on a global scale.

Kailee Nardi

Photo: Flickr

Medical Anthropology Improves AidMedical anthropology, the study of health and healthcare in the context of specific cultures, exemplifies how the application of social sciences can improve policymaking. Medical anthropologists work within communities and observe health behaviors, which provides them with qualitative data that can inform healthcare-related aid. In this way, medical anthropology improves aid. Medical anthropologists have not only created aid organizations, such as Partners in Health, but also identified health issues in developing nations and discovered ways to make aid implementation more effective.

When Ebola began spreading rapidly throughout Liberia and Sierra Leone, knowing the cause of the disease was not enough to help aid organizations combat it. In 2014, the World Health Organization conducted medical anthropology-based research to pinpoint what was promoting the virulence of the disease. Among other data, the study found that the culture of burial in Liberia and Sierra Leone contributed significantly to the spread of Ebola.

WHO and other organizations’ attempts to quell Ebola include the cremation of the virus’ victims. However, the locals of Liberia and Sierra Leone view such a practice as an affront to their culture and traditions. In these regions, it is customary to have intimate contact with bodies during funeral ceremonies, including washing the corpse and even kissing it.

In order to eliminate the influence of regional funeral customs on Ebola transmission, WHO began promoting culturally compliant alternatives to burial rather than cremation. Funeral ceremonies performed for individuals who have died in war, which do not require a physical body, are now an encouraged alternative for the burial of Ebola victims. For the moment, Ebola outbreaks have been controlled. According to the CDC, over 25,000 cases of Ebola were recorded in West Africa between 2014 and 2016, while only 8 cases were reported from May 2017 to July 2017.

The Ebola crisis is not the only example of how medical anthropology improves aid and contributes to better global health. In 1997, researchers at the University of South Florida searched for cultural explanations for the shocking prevalence of dengue fever in the Dominican Republic. They discovered that, for a start, dengue education needed to be reformed.

In Dominican culture, women are in charge of collecting water for the household, so health organizations teach women how to clean water and prevent mosquitoes, the vectors of dengue fever, from breeding. However, men in Dominican communities control stored water, kept outside the home. The anthropologists discovered that men had not been taught how water sources and dengue were related, and thus left stored water sources uncovered, which allowed dengue-carrying mosquitoes to spawn.

The insight provided by medical anthropology allows aid organizations to implement healthcare reforms in culturally sensitive ways that are cohesive with local traditions, which in turn makes them more effective. Additionally, living within a culture, as many anthropologists do, helps them detect overlooked behaviors that may seriously impact health and healthcare initiatives.

Mary Efird

Photo: Flickr

Rebuilding Liberia After EbolaOn January 14, 2016, the World Health Organization (WHO) declared Liberia Ebola-free. As a result, the region of West Africa was officially free of the virus. Ebola was widespread throughout West Africa and cases occurred in the U.S. The country of Liberia was hit particularly hard by the virus between 2014 and 2016, with over 10,000 cases and a 45 percent fatality rate. Furthermore, since the outbreak, there have been many consequences. What has been done to address those consequences and rebuild Liberia after Ebola?

Both during, and after, the Ebola crisis, Liberian doctors worked with organizations like the WHO on the front lines to combat Ebola. In order to build-up medical infrastructure in Liberia, communities have engaged with nonprofit organizations. From the beginning of the crisis, Doctors Without Borders has been working with the government of Liberia and it continues to do so.

Ebola Treatment Units have been created to act as the first point of contact for people who are believed to have Ebola. The staff is trained and ready to respond to patients who show Ebola symptoms. Vaccines have also been distributed to centers across the country and they have been reported to be effective. People working in clinics have learned how to identify the disease and how to handle it.

The government of Liberia, with the support of the World Bank and United Nations, has created a plan for reconstructing the healthcare system, known as “Building a Resilient Health System.” Specifically, it plans to build new infrastructure and medical centers, which allows medical staff to care for various medical problems, not just outbreaks of the virus.

Psychiatrists and clinics are helping survivors and family members cope after the tragedy. The nonprofit More Than Me has worked to help reintegrate survivors back into the community as well.

It important to note that the chance of another outbreak is both likely and deadly in a developing country. This is due to a lack of understanding on how the virus is transmitted and how long it persists in one’s system. The Ebola virus still exists and could be transmitted by animals. This is why it is important for these organizations to continue outreach and awareness programs in Liberia, which teach Liberians about the disease.

While there is more to be done to rebuild healthcare systems in Liberia after Ebola, there is hope. According to an article by Al Jazeera, “Ebola has also united Liberians and brought greater trust into the health system, which is finally seen as the government priority.”

Liberia after Ebola is a changed Liberia. Families must deal with the social and economic fallout, while survivors and doctors must worry about when the virus may return. However, Liberians are better prepared to take on the virus in the future, thanks to the work of Liberian communities and medical organizations and nonprofits.

Emilia Beuger

Photo: Flickr

Hemafuse: Clean Blood Transfusions in Impoverished CountriesIn the U.S., there are many people who are willing and able to donate their blood. With a large blood bank available, the U.S. does not have to use extreme measures to perform a blood transfusion. Unfortunately, this is not the case with many impoverished countries; getting a clean blood transfusion in most of these countries is simply not an option. However, a device called Hemafuse has been developed for doctors to help make these clean blood transfusions possible.

Due to the lack of blood donors in poverty-stricken countries, doctors use autologous transfusions to give the patients the blood they needed; this involves using the patient’s own blood for the transfusion. It could be obtained during hemothorax – a condition where the patient’s blood has pooled up in an open cavity, or, alternatively, they could also use the blood resulting from hemorrhaging during an ectopic pregnancy – pregnancy which occurs outside the uterus.

Originally, doctors had to scoop up the patient’s pooled blood with nothing but a soup ladle. They then took the blood collected from the soup ladle and poured it through a filtration system to make the blood cleaner for transfusion. Not only is this unsanitary, but it is a highly complicated process that takes many doctors to perform. It has saved a few lives in the past, but it is inadequate as a permanent solution.

The Hemafuse looks to alleviate all of those problems and make clean blood transfusions in impoverished countries happen. To operate the Hemafuse, doctors need to put the suction inlet into the pooled blood and then pull the pump. Blood is then filtered through the filtration system, removing clots and impurities. After the blood is collected, the doctor then pushes the pump and the blood is then moved into a separate blood bag that is connected to the side of the device. Once there, the blood can be used in a blood transfusion back to the patient the blood originally came from.

This is much safer and cleaner than using a soup ladle. The patient’s blood stays within a closed and sterile system rather than it being exposed to the elements. Not only that, it requires only one or two doctors to use rather than the eight or nine that were previously required. It also costs about $60 per patient use, which is much more affordable than the $250 a normal blood bag would cost.

The Hemafuse device has been backed by many prominent organizations such as USAID, UKAID and the Gates Foundation, among many others. Doctors want clean blood transfusions in impoverished countries to become widespread, so they are willingly coming around to performing clinical trials using Hemafuse. With this device, the soup ladle transfusion will hopefully become a procedure of the past and patients will finally be able to receive the – clean – lifesaving blood that they need.

Daniel Borjas
Photo: Flickr

Gavi

In his proposed 2017-2018 budget, President Donald Trump has pledged to fulfill the U.S.’s $1 billion commitment to Gavi, the Vaccine Alliance. The program has helped immunize hundreds of millions of children and lowered the cost of vaccinations since its creation in 2000.

Gavi, the Vaccine Alliance is an international organization that “aggregates demand” for vaccines from the countries it supports— 60 percent of the world’s births take place in Gavi-supported countries. This demand sends “a clear signal to manufacturers” that these countries are viable markets for vaccines. Countries supported by Gavi pay for a portion of their vaccine programs, but as “a country’s income grows, its co-financing payments gradually increase to cover the full cost of vaccines.” Gavi relies on large donors to run this business model.

In January 2015, USAID dedicated $1 billion to Gavi in support of the organization’s plan to “immunize 300 million additional children and save at least 5 million lives by 2020.” The Obama administration was vocally supportive of global poverty reduction efforts— Obama addressed extreme poverty in three of his State of the Union addresses— but the Trump administration was not expected to contribute to poverty reduction efforts to the same extent. Trump’s pledge to Gavi is refreshing in the midst of the 32 percent overall cuts to international aid proposed in his budget.

Gavi’s website lists the U.S.’s contribution to the program for the period of 2016-2020 as $800 million. If Trump were to have cut the U.S.’s funding for Gavi, the organization would have lost close to a ninth of its $9.2 billion budget. Reducing aid to Gavi would have further damaged the U.S.’s aid reputation, as it spends the least on foreign aid of all developed countries, especially since other countries fund the majority of Gavi’s budget. Notably, the U.K. has contributed $2,515 million, Norway $922 million, and Germany $676 million for the same 2016-2020 cycle.

It is important that the U.S. continue to support international vaccination programs like Gavi, the Vaccine Alliance as they allow healthier populations to become more stable, self-sustaining and economically stronger. Gavi projects $100 billion in economic gain worldwide as more people are immunized and the world moves closer to global poverty eradication.

Caroline Meyers

Photo: Flickr

Zipline Drones

The California-based company Zipline, which designs and operates drone delivery networks, will start delivering medical tools and vaccines via drones to Tanzanian clinics in 2018.

The East African country has 0.03 doctors per 1,000 people and 5,640 public health facilities for a population of over 56 million. Blood transfusions and treatments for deadly diseases like HIV are hard to come by. In 2014, the CEO of Zipline drones, Keller Rinaudo, noticed this harsh reality as he browsed a database of health emergencies. The database would collect real-time data about patients who were suffering in different regions of the country, but people would not receive aid based on this information. Rinaudo, as he states in an interview with NPR, imagined “the other half of that system — where you know a patient is having a medical emergency and can immediately send the product needed to save that person’s life.”

The ‘other half of this system’ will start in January 2018, as per a statement from the Tanzanian government. Drones will be used for on-demand delivery of vaccines, blood transfusion materials and other medication or medical tools.

A drone medical delivery system is already up and running in Rwanda, with overwhelmingly positive results and stories. Tanzania hopes for an even larger system, where 120 drones will make 2,000 deliveries a day from four distribution centers spread across the country.

Zipline has hired locals to operate both the drones and distribution centers. When a hospital or clinic requests an item, a worker will stock the products into a shoebox-like container and pack the drone, which would zip to the hospital and deliver the products by parachute. This process takes what could be an eight-hour process and cuts it down to under a half hour.

The medical future is bright for rural and impoverished communities like those in Tanzania with the help of drones. Studies have found that blood samples and lab results were safely transported between medical facilities without any change in result, except for the time they took to be transported.

Rinaudo sees the system as a win not only for his Zipline drones company, Rwanda, or Tanzania, but for medical communities across the globe. In the same interview with NPR, he says that operation teams are “phenomenally smart, ambitious and driven. They work 12 hours a day, seven days a week. They will do anything to save human lives…Rwanda showed what’s possible when you make a national commitment to expand healthcare access with drones.”

Gabriella Paez

Photo: Flickr