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2 Diseases Impacting Afghanistan

Diseases Impacting AfghanistanSince the early 2000s, Afghanistan’s disease prevention and treatment services were far below sustainable, with only 11 physicians and 18 nurses per 100,000 civilians working in 2003. As foreign aid began to pour in, these numbers slowly improved. However, infant, child and maternal mortality rates remain the highest globally, alongside many other diseases impacting Afghanistan today. Currently, two diseases impacting Afghanistan include tuberculosis and polio, which the Western world is well equipped to diagnose with far less difficulty.

Tuberculosis

Tuberculosis is a highly infectious, airborne disease impacting many Afghan people. Tuberculosis symptoms include a dry cough (sometimes with blood), fatigue, loss of appetite, night sweats and others. Yet, early diagnosis and quality treatment are easily accessible in the United States, preventing mass outbreaks.

The World Health Organization states that tuberculosis kills around 13,000 Afghans yearly, making it a disease that impacts Afghanistan severely. In 2014, Afghanistan had approximately 58,000 new tuberculosis cases. Only 56% of these cases were diagnosed and provided with adequate treatment. Keeping the disease at bay only becomes more challenging with up to 25,000 Afghan people left undiagnosed and untreated.

However, with WHO’s help, BRAC Afghanistan and USAID started a community-based TB DOTS program to control tuberculosis outbreaks. Through the program, diagnostic facilities for tuberculosis expanded and existing facilities were further equipped with microscopy screening technology. After the initiation of these health programs, more Afghans saw doctors and received treatment for tuberculosis: Since the program’s launch in 2004, access to dots has expanded from 15 to 121 clinics two years later. By 2006, more than 6,000 community health workers had trained under the program, of which 53 percent of trainees were women. Through the continued funding and advancement of the TB DOTS program, tuberculosis may slowly begin to lose its footing and become a lower-risk illness.

Poliomyelitis (Polio)

Polio is a viral illness that can lead to severe nerve damage and injury, eventually leading to paralysis and sometimes death. Afghanistan, Nigeria and Pakistan remain the only countries worldwide that have yet to eradicate polio. Due to inconsistent vaccination rates at birth, polio remains a disease impacting Afghanistan heavily today. In the 2015 report by the polio eradication initiative, researchers found that reported polio cases in Afghanistan had decreased since years prior. However, Afghanistan is still far from eradication.

In efforts to eradicate the polio virus worldwide, UNICEF worked with WHO to find innovative ways to give every child polio vaccines. The program implemented three National Immunization Days (NIDs) to increase access to polio vaccines and potential treatment if necessary. NIDs aim to reach nearly 10 million children through house-to-house and health facility-based approaches.

Furthermore, in collaboration with UNICEF and WHO, Afghanistan’s Ministry of Health is investing in a polio program to support vaccinators, community mobilizers, influencers, volunteers and campaign coordinators to reach children in need of vaccines. According to UNICEF, 392,000 polio branded items were distributed in 2020 to Afghan students to raise awareness about the disease’s severity, prevention and symptoms. As efforts continue, polio may become a disease impacting Afghanistan far less than before.

Why it Matters

Though efforts to improve health care access and treatments in Afghanistan have increased, much work still needs to be done. Today, tuberculosis is a disease that the U.S. quickly diagnoses and treats, while, in Afghanistan, the disease is often more threatening.

Afghanistan’s Ministry of Public Health and emergency operating system know how to help their people lead healthier lives yet lack the resources to do so. In funding programs that help international organizations and ministries provide the support needed for their people, both tuberculosis and polio can become low-priority diseases for all.

– Opal Vitharana
Photo: Flickr

How TB Affects Refugees

TB Affects RefugeesTuberculosis (TB) is one of the most commonly reported diseases among refugee populations. It affects the lungs and can be extremely infectious. Symptoms include coughing up blood and mucus for a long period of time, pain when coughing, fatigue, fever and chills. TB is a highly contagious disease and can spread through droplets in the air when an infected individual sneezes or coughs. TB affects refugees who usually become infected while they are in their home countries. Poverty increases during wartime, and so do TB rates.

The Diffusion of TB

Although many refugees contract TB from their home countries, their journies worsen the disease’s effects. The malnutrition that many displaced peoples experience weakens the body’s ability to fight the disease, and underlying health conditions lead to more life-threatening effects.

TB affects refugees in camps. Currently, 2.6 million refugees live in refugee camps all around the world.  Tens of thousands of individuals can cram into each camp.  In fact, one camp in Jordan, for example, is home to about 80,000 Syrian refugees. Camps do not have an adequate amount of food, and sanitation is well below average. In fact, 30% of refugee camps do not have access to proper latrine systems. Additionally, TB affects refugees where HIV rates are high. For example, many refugees live in sub-Saharan Africa where the HIV rate is 9%, one of the highest in the world.  Further, when those placed in camps leave, general community members are also at risk.

Access to Treatment

The majority of refugees today are living in a state of poverty. For example, a report by the United Nations High Commissioner for Refugees (UNHCR) and the World Bank Group shows that in 2014  90% of the Syrian refugees in Jordan and Lebanon are considered to be below the poverty line in each of those countries. Economic barriers prevent many refugees from TB treatment. Without money, displaced peoples have little defense against TB.

Although affordability plays a large factor in a refugee’s inability to access treatment, fear also plays a role in limiting refugee access to treatment. Particularly for undocumented refugees, the fear of deportation prevents many from receiving a diagnosis. For documented refugees, the legal technicalities of receiving such care are complex. Treatment is mainly available to those who are employed because employers provide insurance that covers treatment costs. However, approximately 65.1% of refugees around the world are currently unemployed and unable to receive these benefits. Financial and emotional walls are blocking refugees from receiving vital healthcare.

Global Response

The extreme ways in which TB is affecting refugees have garnered international attention. To combat its fatal consequences, the World Health Organization (WHO) has created a response called The End TB Strategy. The program’s ultimate goal is to reach an 80% drop in TB cases by 2030. One of the program’s main strategies is to implement screening, especially for high-risk groups. If a refugee arrives from a country such as India where TB rates are high, they will go through a screening process. Through these procedures, early detection of TB is possible, and the disease can be effectively treated.

Organizations like the Centers for Disease Control (CDC) have already implemented screening measures and require refugees to undergo TB tests before they can cross US borders. Proper understanding of the disease is also a focus of The End TB Strategy. The WHO is developing research on and treatment plans for TB that should lower infection rates. In general, the strategy emphasizes the importance of early detection, screening and proper treatment for all individuals.

Looking Forward

Tuberculosis is a deadly disease. It is one of the top ten causes of death in low-income countries. Refugees can become infected in their home countries, throughout their journeys or in refugee camps. TB easily spreads from person to person, and it can infect entire communities. Poverty and fear of deportation and unemployment prevent refugees from accessing and receiving treatment.

Fortunately, plans such as the WHO’s End TB Strategy are working on improving the current state of tuberculosis among refugee populations. Hopefully, these programs will reach their goals and protect refugees from TB’s deadly hands.

– Mariam Kazmi
Photo: Flickr

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5 Things To Know About Pott’s Disease

Pott’s DiseaseInfectious diseases are one of the main results of poverty in the developing world. In addition, the prevalence of infectious diseases has long been disparate between developing and developed nations. In a report on environmental risk factors and worldwide disease, the World Health Organization (WHO) affirmed the “total number of healthy life years lost per capita was 15-times higher in developing countries than in developed countries” for infectious diseases. Yet, one disease continues to be the deadliest infectious disease in the world, killing approximately 4,000 people a day: tuberculosis. Tuberculosis is a devastating widespread illness in the developing world, specifically in Asian and sub-Saharan African nations. However, tuberculosis of the spine called Pott’s Disease is a serious concern for the developing world. Read on for five things to know about Pott’s Disease.

5 Things To Know About Pott’s Disease

  1. Pott’s disease gets its name from a British surgeon. Though it is also referred to as spinal tuberculosis, the namesake of Pott’s Disease takes after British surgeon Percivall Pott. Pott originally studied and defined the condition in 1779, and his writings and research are still used today.
  2. Pott’s disease begins when tuberculosis spreads to the spine. Tuberculosis is an airborne infection that begins when an individual inhales mycobacterium tuberculosis, the bacteria that causes the disease. If tuberculosis goes untreated for a long period of time (which it often does in the developing world due to lack of access to healthcare and low-income citizens who cannot afford medication), the disease can spread from the lungs to the spine. Once this happens, an individual experiences a type of “spinal arthritis.” Tuberculosis bacteria invades the spinal cord and, if it infects two neighboring spinal joints, blocks the nutrient supply to that region of the back. Eventually, the spinal discs deteriorate and can cause serious back injury, difficulty standing or walking, nerve damage and, in serious cases, paralysis.
  3. Pott’s disease is visually recognizable and has existed for centuries. Unlike normal tuberculosis, which most commonly affects the lungs, Pott’s disease is easily visually recognizable due to the severe curvature of the mid to lower spine that results from the infection. Specifically, the thoracic spinal region is the most affected, followed closely by the lumbar region. This visual indication from remains traces the disease back to the European Iron Age and Egyptian mummies, making it one of the oldest documented diseases in history.
  4. Spinal tuberculosis only represents a small percentage of all tuberculosis cases. Although it is the most debilitating form of tuberculosis, Pott’s Disease only accounts for 1.02 cases per 100,000 tuberculosis cases in the world. This rate is higher among Africans, where 3.13 per 100,000 cases are attributed to Pott’s Disease. Globally, this means that only 1-2% of all tuberculosis cases are attributed to that disease.
  5. Pott’s disease can be treated through a rigorous medication regimen or surgery. Pott’s Disease is a result of a lack of treatment over a long period of time; conversely, a lengthy period of medication is often needed to fully treat the condition. The time period of treatment ranges from nine months to over a year, depending on individual symptoms and progression. However, medication cannot redeem an affected individual’s deformed spinal structure. Thus, it is often only used to treat the tuberculosis infection after surgery. “Spinal fusion or spinal decompression surgeries” can both repair the warped spine and “prevent further neurological complications.” Physical therapy is also often necessary after receiving spine surgery for Pott’s Disease. Yet, treating Pott’s Disease is highly expensive. Even when tuberculosis medication is free, “patient costs associated with TB treatment can be upwards of 80% per capita income in some regions.” However, multiple organizations exist that provide donations to supply healthcare and surgeries to low-income patients in developing nations. In addition, specific organizations like the Nuvasive Spine Foundation provide life-saving spine surgery in vulnerable regions around the world.

Although Pott’s Disease represents a small percentage of all tuberculosis cases, it is a serious illness. However, through the help of surgeons, medication and awareness, the disease can hopefully be treated across the globe soon.

– Grace Ganz
Photo: Flickr

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Healthcare in Lesotho: 5 Interesting Facts

healthcare in lesotho
Lesotho, a small nation in southern Africa, is continually improving its access to healthcare systems. Still, even with greater access to healthcare services in some of the areas that are more difficult to reach, long treks and expensive rides are necessary to receive essential care. Due to the state of remote villages being located far from hospitals, patients are not able to receive help immediately in case of an emergency.

Lesotho is also the only country in the world that has its entire elevation above 1,000 meters, which means the terrain may be harder to navigate and maneuver. The life expectancy for Lesotho averages around 53 years for both males and females and deaths under 5 occur 8.1% of the time. However, despite all these limitations, Lesotho has remained committed to improving the well-being of its citizens. Partnerships with private companies, expansions to the hospital network and increased government funding to aid programs have all been policies implemented to invest in Lesotho’s health infrastructure. These five facts about healthcare in Lesotho are integral to understanding the country’s changing health structures and transition out of poverty.

5 Facts About Healthcare in Lesotho

  1. Lesotho is at an elevated risk for HIV and Tuberculosis, consistently ranking in the top 20 countries by an estimated absolute number of incident cases. Predictions estimate that less than half of the approximate 12,000 cases of HIV/TB co-infected patients are even diagnosed each year, much less treated for their symptoms. Estimated TB incidence is about 724 per 100,000 individuals in the population, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) reports. Understanding that the necessary objective is to expand TB testing and treatment coverage, Lesotho is working to increase and optimize its GeneXpert equipment to meet the demand.
  2. Partners in Health, known locally to the people of Lesotho as Bo-mphato Litsebeletsong Tsa Bophelo, works directly with the government of Lesotho to reform and improve the healthcare infrastructure system as a whole. After a government invitation in 2006 to aid in Lesotho’s response to the HIV epidemic, Partners in Health expanded a primary healthcare program to reach over 90,000 people at mountain clinics in remote areas of the country. Partnered reform for HIV/TB co-infection began in 2014, with Partners in Health as the primary adviser to the government of Lesotho. Thus far, the expansion of health systems has reached more than 70 health centers and about 40% of Lesotho’s population. With special focuses on maternal and child health going forward, Partners in Health looks to continue Lesotho’s health development.
  3. One of the most unique government healthcare services in Lesotho, the Flying Doctor Service, provides aid by plane to rural areas. However, even in these hard-to-reach mountainous areas, the Flying Doctor Service does more than provide treatment. In addition to emergency medical service, the service also implements healthcare programs and brings essential medical supplies like vaccines to areas in need. The Flying Doctor Service uses Cessna 206 single-engine planes, stocked with stretchers and first aid kits, to deliver care to the people of Lesotho. Even countries like Ireland have supported the Flying Doctor Service in Lesotho, committing to provide flights to Lesotho to assist the aid efforts.
  4. Public-private partnerships have been an essential part of Lesotho’s healthcare development in the infrastructure department. The International Finance Corporation of the World Bank has recently been working with the government of Lesotho to develop hospitals and health centers around the mountainous regions. The Queen ‘Mamohato Memorial Hospital in the country’s capital, Maseru, was recently developed and opened for patients. Replacing the Queen Elizabeth II Hospital, where infrastructure was debilitating and services were poor, the new Queen ‘Mamohato Memorial Hospital is truly world-class. With state of the art operating rooms, a maternal ward, nursery, Intensive Care Unit and other services, the new hospital built with help from a $6.25 million grant from the World Bank Group.
  5. In 2016, the maternal mortality rate in Lesotho was about 618 deaths per 100,000 live births. Though this mortality rate is favorable when compared to the 2014 statistic of approximately 1,024 deaths per 100,000 live births, it is still too much too high for Lesotho. This exceptionally high maternal mortality rate is a result of the poor services provided during pregnancy, childbirth and after delivery (especially to those in rural areas of Lesotho). Postnatal care is also imperative to ensure the safety of the mother and child after delivery but only around 62% of mothers and 18% of newborns receive the recommended treatment.

In the fight against poverty and for a stronger healthcare system, Lesotho has much work to do. There has been progress on the infrastructure front and with public-private partnerships but many services to the rural population still lag behind what is necessary. However, with continued government support and increased foreign aid, the healthcare system will continue to develop and Lesotho can become a country that provides a robust healthcare system for its growing population.

– Pratik Koppikar
Photo: Pikist

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Tuberculosis in Timor-Leste: An Overview

Tuberculosis in Timor-Leste
Tuberculosis, also known as TB, is a bacterial disease that affects one’s lungs. The disease can cause symptoms such as coughing fits, sneezing, as well as troubled breathing; however, some people do not exhibit symptoms. Tuberculosis is an air-borne disease that can be exchanged through interacting with individuals who have tuberculosis, typically by either coughing or speaking.

There are also two different types of tuberculosis: latent TB infection and TB disease. Latent tuberculosis occurs when an individual has the bacteria that causes tuberculosis in their lungs but shows no active symptoms of tuberculosis; therefore, there is no spread of the bacteria. Tuberculosis disease refers to when an individual has the bacteria in their lungs and is showing symptoms due to the growth of the bacteria. The disease is typically treated through a mixture of different antibacterial medications, taken for six months to a year.

Though tuberculosis may not sound dangerous, there are some dangers for those who do not receive proper medical treatment. While TB does directly affect the lungs, the bacteria can also affect other organs such as the brain and kidneys, which can cause more concerning health issues like renal failure. Renal failure causes the kidneys to malfunction, so waste is not properly removed from the body. If not treated, tuberculosis can cause the lungs to be filled with fluid and blood and can ultimately result in death.

Which Countries are Most at Risk?

Timor-Leste, located in Southeast Asia, is one of the countries most affected by tuberculosis. Unfortunately, many people are not diagnosed, causing the disease to go on untreated. Timor-Leste has limited medical resources and supplies. As of 2017, the WHO estimates that for every 100,000 people in Timor-Leste, only 498 people are notified that they have tuberculosis, and 106 are killed annually.

83% of the treatment for tuberculosis in Timor-Leste comes with an enormous fee. Due to this, many are reluctant to be treated or even tested for tuberculosis in Timor-Leste. It is also estimated that in 2017, 46% of individuals living with tuberculosis in Timor-Leste have gone undiagnosed. Therefore, there is a dire need for education about tuberculosis in Timor-Leste. Many do not understand the disease or the medical treatment they are receiving and end up not completing the whole treatment.

What is Being Done to Help Timor-Leste?

According to the World Health Organization (WHO), certain programs have been created across Southeast Asia to teach tuberculosis prevention. Overall, there are thirteen districts, each of which focused on a different campaign. Originally, the program was started to address the missing cases in Timor-Leste. The WHO has also implemented more test screenings and treatment. It hopes to execute the “TB Free Core Package” in which there will be more TB prevention, detection, treatment, and protection. This package would be focused on helping low-income families who cannot afford the hefty price tag that comes with TB treatment. As the WHO programs have reached thousands of individuals, there is hope to decrease the number of TB cases and better educate the Timor-Leste public on tuberculosis prevention.

The International Organization of Migration and UN Migration Agency are working with Timor-Leste’s health ministry to help fund more test screenings. Supporting the National Tuberculosis Program will allow screenings to become more available to the public; as of 2018, more than 6,000 individuals have had a screen test. Programs such as this pave the way for more partake in reducing the cases of tuberculosis in Timor-Leste.

– Olivia Eaker
Photo: Flickr

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What to Know about Tuberculosis in South Africa

Tuberculosis in South Africa
Tuberculosis (TB), a bacterial disease, is contracted through airborne respiratory droplets from an infected individual. TB is also contractible from unpasteurized milk containing Mycobacterium Bovis, or Bovine Tuberculosis. Pulmonary TB primarily affects the lungs, but more than 90% of individuals with TB have a latent form known as drug-resistant TB (DR-TB). With tuberculosis as the leading cause of death in South Africa, the government and other organizations are working to help those with the illness. The South African government, with aid from the international community, is slowing the spread of TB through treatment, premature diagnosing, proper medical training and accessible testing. Here is what you need to know about tuberculosis in South Africa.

Tuberculosis: the Leading Cause of Death in South Africa

Tuberculosis is a major public health threat in South Africa, causing more than 89,000 deaths annually. Even so, the government is making strides toward eradicating TB in South Africa. Medical professionals in South Africa encourage early intensive action by screening all patients attending a primary medical provider. While premature screening is an important measure, it is also critical that the South African government encourages and helps individuals receive testing and remain on the treatment.

Treatment Availability and Effectiveness

Most individuals with TB are curable with a series of medicines. There are currently four recognized medicines that can treat TB: Isoniazid (INH), Rifampin (RMP), Pyrazinamide (PZA) and Ethambutol (EMB). After patients take the drugs for three to nine months and depending on the dosage, their bodies can successfully be rid of the bacteria. However, there is a handful of cases that are multi-drug resistant (MDR-TB). Around 1.8% of the new cases in South Africa are MDR.

For those with DR-TB, the efforts of medical professionals and the government are poor. Treatments become inaccessible for many South Africans. Many local clinics run out of medication for MDR patients, or the wait times to receive prescriptions are several hours long. As a result, patients must go to hospitals also with long wait times and crowded waiting rooms. For individuals who lack the time, money and resources to wait, there are few alternatives. This discourages those with an MDR-TB diagnosis from finishing their treatment plans. If a patient skips one dose of the six-month long medication regime, TB can resurface in the individual and come back much stronger. It is crucial that the government of South Africa, with help from other countries and organizations, provide better accessibility to testing, medicine and capable medical staff to its citizens.

Other Obstacles to Overcome

Much of the spread of TB is the result of unknowingly transmitting the disease or total neglect to seek testing because of inaccessibility or social stigmas. The stigma surrounding a TB diagnosis is a real problem. In 2014, the South African Stigma Survey reported that teasing and mockery affect more than a third of individuals who have TB.

Poverty is also an important dimension. On average, treating a regular case of TB would cost 2,500 rand (about $144.05), which is a steep cost for families in a country with a poverty rate of nearly 50%. To reduce TB deaths in South Africa by 90% would cost the government five billion rand per year, or more than $288 million. However, with help from other countries and organizations, eradicating tuberculosis is possible.

HIV, COVID-19 and TB

HIV comorbidity with tuberculosis has been a fatal combination for decades. More than 6 million South Africans live with HIV, yet only one million were screened for TB in 2013. In 2014, only 34,000 of the millions of people eligible for testing received a test.

Now, according to studies from June 2020, researchers believe citizens with active TB are 2.58 times more likely to die after contracting the coronavirus. Still, TB and HIV pale in comparison to other major risk factors for COVID-19 like diabetes or old age.

The skills medical professionals have gained from treating patients with HIV and TB will hopefully help in handling the novel virus. Being familiar with protective gear, tracking diseases and reducing the spread of illness are all important ways in which TB has prepared South Africa for the pandemic.

Organizations in the Fight against Tuberculosis

The South African government could take several actions to mitigate cases of tuberculosis in South Africa. One potential preventative action is active case finding, where health professionals search communities for individuals with TB. Another action is contact tracing, the method of finding patients who have TB and testing those with whom they have been in contact. Many NGOs and campaigns are stepping up to help the government fight TB.

In 2015, the World Health Organization (WHO) adopted a new plan to tackle the epidemic of tuberculosis in South Africa entitled the End TB Strategy. In collaboration with the National TB Programme, the WHO encourages South Africa to research, use new innovative medicines and tools, collaborate across all sectors of government and properly assess the threat of TB in influenced areas. In addition, The TB Alliance helps to end the spread of tuberculosis by funding clinical drug trials for MDR-TB in South Africa.

 

When considering what the “ideal clinic” is, only 10% of the clinics in South Africa make the cut. These clinics have ample supplies, educated staff and fair policies. It is critical that the South African government receives enough funding to help more clinics reach this status and stay on track to significantly diminish TB by 2035.

– Danielle Kuzel
Photo: Flickr

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The Tuberculosis Crisis in Gabon

As of 2018, Gabon had the third-highest rate of tuberculosis among African countries, with a yearly occurrence of 428 cases per 100,000 people. Tuberculosis is so prevalent in Gabon, in part, because it often goes undiagnosed and is poorly treated. In addition, the rates of local transmission and drug resistance are high, leading to a tuberculosis crisis in Gabon.

Limited Laboratory Access

Effective diagnosis and treatment of tuberculosis in a laboratory setting is crucial to the prevention and treatment of the disease. Limited access to laboratory diagnosis is one of the main contributing factors to the tuberculosis crisis in Gabon. CERMEL, a not-for-profit center for research in Lambaréné, is the country’s foremost resource for tuberculosis research. In the past decade, CERMEL has held events regarding the treatment and diagnosis of tuberculosis, through which doctors share research and information. Though the center was established over 30 years ago, CERMEL has devoted considerable resources to tuberculosis only in recent years. Gabon has also received support from the Global Fund, an international financing and partnership organization. Before 2015, however, the country was receiving no outside financial support to deal with the tuberculosis crisis.

Tuberculosis and HIV Co-Infection

Another issue Gabon faces is the simultaneous prevalence of tuberculosis and HIV. In 2012 and 2013, the co-infection rate of these diseases was 42% in adults and 16% in children. The mortality rate for those infected by both TB and HIV was 25%.

Cultural and Social Obstacles to Professional Healthcare

Cultural and socioeconomic factors contribute to Gabon’s high infection rates and low treatment success rates. When it comes to TB, patients often do not follow “doctor’s orders.” This is largely due to patients’ belief that they can be healed by visiting a spiritual doctor, rather than by going to the hospital. Additionally, high transportation costs and improper diagnosis and treatment prevent patients from taking healthcare professionals’ advice seriously.

Multidrug-Resistant Tuberculosis

The prevalence of multidrug-resistant tuberculosis, or MDR-TB, is yet another concern. Like many countries in sub-Saharan Africa, Gabon has limited access to the second line of drugs used to treat tuberculosis in drug-resistant cases. The first MDR-TB treatment center was opened in Gabon in 2015, in Lambaréné, with the laboratory support of CERMEL. The German Ministry of Health provided funding for a trial study of second-line drug treatment for patients in Gabon, which showed positive effects — 63% of patients were cured. However, the drugs used in second-line treatment are harsh and often cause adverse effects, such as gastrointestinal problems.

Expanding laboratory infrastructure will be invaluable in stopping the tuberculosis crisis in Gabon. As it stands, CERMEL is one of the only research laboratories in the country and newer data on TB is not available. CERMEL has helped get the ball rolling for research on the disease, but further laboratory spaces and doctors are necessary. Additionally, to quell the tuberculosis crisis in Gabon, healthcare professionals will have to engage the population in ways that account for prevailing cultural beliefs and socioeconomic realities.

– Elise Ghitman
Photo: Flickr

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What to Know About Tuberculosis in Somalia

tuberculosis in SomaliaTuberculosis is a disease caused by bacteria that spreads through the air. While it can also be spread through the consumption of unpasteurized milk contaminated with the bacteria, the most prevalent form of the TB infection is pulmonary TB. In rare cases, TB can also affect the lymphatic system, central nervous system, urogenital region, joints and bones.

In Somalia, one of the world’s most poverty-stricken nations, less than half of estimated cases of TB are detected. Not all tuberculosis strains are equal, making diagnosis and treatment more difficult. While antibiotics typically treat TB, studies have shown that the prevalence of drug-resistant TB has increased. Somalia has a recent history of a tumultuous political climate, exacerbating obstacles that might prevent the delivery of efficient healthcare, like fund allocation and accessibility.

Diagnosis

In a cultural profile of Somalia conducted in 2006, many believed the disease was spread through airborne particles resulting from coughing or sneezing. These same people often believed that the contraction of TB also comes from a variety of things including it being inherited or the result of a loss of faith, creating stigmas around the disease.

Many people distinguished TB from other ailments with respiratory symptoms through weight loss and the presence of blood in the mucus. Until these symptoms are found in addition to an existing cough, it is assumed to be a chest infection. In cases when a fever is apparent, some confuse TB with malaria.

While the primary symptoms (cough, weight loss and bloody mucus) follow the same way the west symptomatically views TB, Somalians understand the progression of symptoms and the disease a little differently. For example, they separate coughing as a symptom into different phases based on the nature of the cough. They focus on whether or not chest pains accompany a cough, or how it sounds. Based on what phase the symptom is in, it might dictate different treatment plans.

Drug-Resistant Tuberculosis

As of 2011, 5% of first-time infected tuberculosis patients had a drug-resistant strain of TB. In comparison, 41% of previously infected patients had this more robust form of TB. These strains are resistant to several drugs used in the treatment of TB. This resulted in the highest recorded instances of multidrug-resistant TB in Africa at the time.

World Vision

World Vision is a global poverty mitigating initiative with boots-on-the-ground efforts. The organization provides healthcare resources, clean water and education to impoverished communities around the world.

Partnering with the Global Fund to Fight AIDS, Tuberculosis and Malaria, the organization has created 33 tuberculosis grants valued at a total of $160.6 million. World Vision has been the primary recipient of tuberculosis grants in Somalia.

In Somalia, World Vision works to fight the frequency of tuberculosis and its drug resistance. With the help of the Global Fund, the organization has treated more than 115,000 people. Additionally, it has trained 132 health professionals in DOTS, the directly observed treatment, short course, as recommended by the WHO. The organization has also helped 30 laboratories with TB microscopy, which resulted in the national health authority documenting 6,505 cases. World Vision continues to strive to strengthen resources within Somalia so that the government and community have a better capacity in which to deal with TB.

– Catherine Lin 
Photo: Flickr

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8 Facts About Tuberculosis in North Korea

tuberculosis in North KoreaTuberculosis (TB) is a bacterial infection that mainly attacks the lungs, and can prove fatal without treatment. Tuberculosis spreads through the air via coughing or talking. It causes people to become sick because the immune system cannot prevent the bacteria from growing. The lengthy and specific nature of the treatment for TB means developing nations can struggle with treating tuberculosis epidemics. One of these nations is the Democratic People’s Republic of Korea (DPRK), which labels TB as one of its most serious health problems. Here are eight facts about tuberculosis in North Korea.

8 Facts About Tuberculosis in North Korea

  1. Though the data on tuberculosis in North Korea is sparse, the rate of instances is estimated to be 442 out of 100,000 people. Furthermore, the WHO estimates that in 2017, the estimated mortality of TB per 100,000 people was 63%. While it had been slowly decreasing since the year 2000 (161%), estimated mortality has risen since 2015 (42%).
  2. North Korea is a poor country, which limits access to healthcare. According to a report by Amnesty International, the healthcare system has been collapsing, with barely-functioning hospitals devoid of medicine. Though the country claims to provide healthcare for all, estimates indicate it is spending under $1 per capita, less than any other nation in the world. Because it is unlikely that the regime will increase healthcare funding, TB patients often do not receive appropriate care.
  3. The inadequately funded healthcare system also means doctors are improperly trained. This results in maladaptive treatment strategies which are expensive and are prone to hijacking by the black market. Hence, many people turn to self-medicating and are unable to access crucial TB drugs. There have been efforts to train doctors through a program in the late 1990s. However, there have not been any in recent years, either from the government or from NGOs.
  4. The lack of documentation and data on tuberculosis in North Korea also causes more serious strains of TB such as multidrug-resistant (MDR)-TB to spread unchecked. Experts estimate that MDR-TB is an already growing problem. Disinformation surrounding TB in North Korea is so widespread. Many people regard TB as so common as to not require a trip to the doctors. Hence, education about the disease is critical. While there have been efforts to educate people about TB, only NGOs (rather than government-sponsored programs), like the Eugene Bell Foundation, have started initiatives to educate patients, though not the general public.
  5. North Korea’s poor track record on human rights also exacerbates its TB and MDR-TB crisis. According to the Health and Human Rights Journal, North Korea’s prison camps and migration across the China-Korea border heighten the risk of citizens contracting TB. Additionally, those migrating or detained are more likely than the average North Korean to receive little or no treatment.
  6. North Korea’s standing as an international pariah aggravates its struggle with tuberculosis. The regime’s totalitarian nature, cold war-era cult of personality, nuclear ambitions and disregard for human rights causes it to face sanctions, political antagonisms and limited medical exchange. International sanctions ban the export of minerals, agricultural products, technology, aviation fuel, metals and more. This results in limited resources, making testing and treatment nearly impossible.
  7. In 1998, the North Korean government began implementing a TB treatment system. Despite North Korea’s reluctance to accept international aid, the government did begin a TB treatment system in cooperation with the WHO. The TB treatment was named DOTS (Directly Observed Treatment, Short-Course). Though it reached the entire country in 2003, DOTS had problems. For example, hospitals turned patients away due to insufficient medicine. Additionally, some medication ended up on the black market.
  8. The only NGO to earn the trust of the North Korean government has been the Eugene Bell Foundation. The Eugene Bell Foundation has been offering support to treat cases of TB since 1996. Focusing on MDR-TB in particular, EBF is the only large scale provider of treatment in the country. Additionally, it has a unique 20-year relationship with the North Korean Ministry of Public Health. The foundation’s program cures an estimated 70% of patients in North Korea. However, despite EBF’s successes in opening clinics, bringing in medication and medical equipment and training doctors, a recent uptick in estimated mortality suggests that North Korea is still a long way away from effectively treating its tuberculosis epidemic.

In conclusion, North Korea faces structural and international challenges that prevent it from being able to treat its tuberculosis and multidrug-resistant tuberculosis epidemic. The regime’s neglect of the healthcare system and disregard for human rights has led to numerous international sanctions, causing it to rely on NGOs and the WHO to treat TB patients. For the situation to improve, wholesale reform of the country’s institutions is likely necessary, though international preventative measures could also help improve the situation.

– Mathilde Venet 
Photo: Flickr

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Mass Incarceration in Colombia: Facts and Solutions

Mass Incarcerations in ColombiaThere is currently a problem of mass incarceration in Colombia. This South American country has a population of nearly 50 million people as of 2018. Currently, Colombian prisons have a capacity of 80,928 people. However, as of May 2020 the incarcerated population reached 112,864, or 139.5% of capacity. The Colombian prison system is known to be very overcrowded. Overcrowded prisons infer and amplify broader social issues. These prison environments amplify the spread of infectious diseases like HIV, tuberculosis and, most recently, COVID-19.

Effects of Mass Incarceration in Colombia on Health

  1. Capacity Rates: There are 132 prisons in Colombia with a total maximum capacity of just over 80,000 people. Despite this capacity, Colombian prisons have reached 139.5% of occupancy, or just over 112,000 people. Women make up about 6.9% of this number—about 7,700 women. Currently, there are no incarcerated in Colombia. Congress has actively fought against the release of prisoners, instead choosing to keep the prisons full.
  2. Effects of COVID-19: Prison riots are becoming increasingly common in Latin America with the spread of the COVID-19 virus. Mass incarceration in Colombia has created panic amongst prisoners, who have demanded more attention to their conditions. The Colombian Minister of Justice, Margarita Cabello, has not outwardly acknowledged the prison riots as demands for better care against COVID-19. Rather, Minister Cabello stated that the riots were an attempt to thwart security and escape from prison. Furthermore, due to the scarcity of doctors, prisoners continue to contract and/or die from complications of COVID-19.
  3. Infectious Diseases: Besides COVID-19, mass incarceration in Colombia has allowed the spread of diseases such as HIV and tuberculosis. Many Colombian prisons have a designated cell block for those who contract HIV, as it is common for prisoners to engage in sexual relationships with guards. Healthcare facilities are not readily available in prisons and condoms are in scarce supply. Active cases of tuberculosis also correlate with mass incarceration in Colombia. Approximately 1,000 per 100,000 prisoners have been diagnosed with tuberculosis. Unfortunately, mass incarceration has further limited prisoners’ access to affordable care.

Striving for Improved Conditions

Local citizens Mario Salazar and Tatiana Arango created the Salazar Arango Foundation for Colombian prisoners. After being imprisoned on fraud charges in 2012, Mario Salazar’s experience drove him to find ways to make prison sentences more tolerable. Salazar and Arango Foundation provides workshops for prisoners in the city of La Picota and puts on plays for fellow inmates. Prisoners have found the organization to be impactful to their self-esteem and their push for lower sentences.

Mass incarceration in the Colombian prison system is both a result and driver of poverty. Issues of food shortages and violence have created poverty-stricken conditions within prisons. Despite these conditions, organizations such as the Salazar Arango Foundation seek to improve the lives of prisoners. Hopefully, with time, external forces will help to reduce the rate of incarceration in Colombia. In essence, efforts to due so would have considerable impact on the lives of prisoners and their families.

– Alondra Belford
Photo: Flickr