HIV/AIDS, tuberculosis, and malaria, or “the big three,” are the three most recognized and targeted diseases afflicting developing countries. These diseases have high mortality rates, killing millions of people each year, and most international efforts to control infectious disease focus on these diseases.

I would like to address some tropical diseases which, although extremely common in developing countries, have lower mortality rates and receive far less international attention. These diseases, which are the 5 most prevalent Neglected Tropical Diseases (NTDs), are not as deadly as HIV/AIDS, tuberculosis, or malaria. However, these parasitical diseases have a great impact on child growth and development, have serious socioeconomic consequences, and can be chronically disabling and painful.

They are, in order of prevalence*:

1. Ascariasis (roundworm), 807 million
2. Trichuriasis (whipworm), 604 million
3. Hookworm, 576 million
4. Schistosomiasis, 207 million
5. LF (lymphatic filariasis), 120 million

*Jotez, Peter. Forgotten People, Forgotten Diseases. 2008

More than one billion people are affected by one or more of these parasitical diseases. But only half a million people die from these diseases each year (as compared to 1 million each from HIV/AIDS and malaria and 1.8 million from tuberculosis). I will talk about each of these diseases briefly, focusing not so much on the medical details, which Wikipedia can supply, but on their socioeconomic impact. While the NTDs are products of poverty, they are also promoters of poverty.

1-3. Roundworm, Whipworm, and Hookworm

These three diseases are caused by soil-transmitted helminths (STHs), helminth being another word for parasitic worm. These worms infect the intestines of humans, and are spread when human feces containing worms are deposited onto soil, where the worms can infect new victims through ingestion of contaminated vegetables or water, or by burrowing directly through the skin. These worms thrive in warmer regions, where they can survive in the soil. The worms grow and mature in the intestines, where they rob the person of important nutrients and impair absorption of protein, fat, iron, vitamins, etc. STH infections can lead to other intestinal problems, such as colitis and rectal prolapse.

By causing malnutrition, STHs stunt the physical growth and cognitive development of children. Clinical studies have shown that STHs negatively affect children’s memory, cognition, and intelligence. They also reduce school attendance. Thus, STHs affect education, which ultimately has a negative impact on economic growth. For instance, studies have shown that “infection with hookworm during childhood is associated with a 43% reduction in future wage-earning capacity” (Jotez, 2008).

While the STHs promote poverty, poverty also promotes STH infections. Places where STH infections are endemic, afflicting much of the population, are also places where people lack sanitation systems and latrines. Dirt flooring in houses and a lack of shoes also allows for easier transmission. In endemic areas in Sub-Saharan Africa, India, and Latin America, anthelmintic drugs are only a temporary fix, because within months the person is usually infected again. Although dosing with anthelmintic drugs has been shown to have the greatest impact on reducing STH infections, economic development also has a great impact. Hookworm infections were once common in the rural Southern United States, but urbanization and economic development, combined with medication, eradicated hookworm.

4. Schistosomiasis

Schistosomiasis is caused by another type of helminth, called flukes. The flukes spend part of their life cycle in snails and are then released into water. When humans come into contact with the flukes, by bathing, swimming, fishing, working in irrigated fields, or drinking un-boiled water, the flukes penetrate their skin and enter the bloodstream, where they cause severe flu-like symptoms, known as “snail fever.” But over time, the flukes penetrate the bladder, kidneys, intestine, or liver, causing organ disease and anemia, and leading to chronic abdominal pain, malnutrition, and weakness. Schistosomiasis reduces a person’s work capacity, and in children, causes many of the same problems as STHs (stunted growth, impaired cognitive development). In many cases, schistosomiasis causes vaginal lesions, which increases the likelihood of HIV/AIDS transmission.

By decreasing children’s ability to learn and succeed in school and the ability of adults to perform both physical and cognitive labor, schistosomiasis, like the STHs, lowers the economic potential of a country. Due to use of praziquantel, an anti-fluke medication, schistosomiasis has been mostly eradicated in Egypt, China, and some Latin American countries. However, in sub-Saharan Africa, schistosomiasis is still prevalent in many countries, largely due to the fact that these countries cannot afford praziquantel (Jotez, 2008).

5. Lymphatic filariasis (LF)

LF is caused by the filarial parasitic worm Wuchereria bancrofti. The worm is spread by mosquitoes, in much the same way that malaria is spread. Unlike schistosomiasis and the STHs, the W. bancrofti parasites do not take up home in the intestines; rather, they infect the lymphatic system, where they release eggs called microfilariae into the bloodstream, so feeding mosquitoes can continue to spread the disease. LF can result in debilitating fever, hdyrocele (swelling of the scrotum), and lymphedema, the most dramatic and apparent symptom. Lymphedema occurs when the worms die, and causes severe swelling of the genitals or legs. Because of the elephant-like appearance of lymphedematous legs, this part of LF is sometimes referred to as “elephantiasis.”

Because the worms die around the time of adulthood, LF has great socioeconomic impact. Young men and women often lose their jobs because they are incapacitated. LF is also stigmatizing, and people with LF are frequently abandoned by their families. In his book, Dr. Peter Jotez describes a young woman with LF who lost her job and was abandoned by her husband.

Like the other parasitic diseases I have described, LF affects some of the world’s poorest people. LF was eliminated by widespread treatment with DEC (a drug that kills microfilariae) in China, Brazil, Japan, Tanzania, Taiwan, and Egypt. Meanwhile, in sub-Saharan Africa, there are many countries who lack the financial means to mass-administer DEC.

The good news is that, with widespread drug treatment, LF could be eliminated worldwide. Humans are the only reservoir for W. bancrofti. A single dose of DEC or ivermectin (another anti-parasitical drug) reduces the amount of microfilariae in the blood for a year. The fact that LF has already been eliminated from several other countries provides hope that one day, with enough drug administration, LF will be eliminated worldwide.

Source: Forgotten People, Forgotten Diseases, by Peter J. Hotez. ASM Press, 2008. Dr. Hotez is President of the Sabin Vaccine Institute in Washington DC, where his team is working on developing vaccines for hookworm and schistosomiasis.

Mobile medical and dental van.

What do you think about when you take a sip of warm coffee, or eat a bowl of blueberries? Six months ago, I would not have answered “migrant workers”. However, through studying abroad in Costa Rica and pursuing a summer experience (funded by the Lang Center for Civic and Social Responsibility) with a mobile clinic outreach program for migrant workers in Oregon, I have been able to learn more about health issues of migrant agricultural workers.

Main street running through a border town. To the right of this street is Panama, to the left, Costa Rica.

Because migrant farmworkers often move between countries and regions, following crop seasons, it is difficult for them to obtain consistent, integrated health care, or to develop ongoing relationships with providers. When providing health care to migrant workers, medical records are usually not available. Near this border town (see picture) in Costa Rica, health workers sometimes set up tents where they vaccinate migrant workers passing through. For vaccines, as with certain other types of medical care, having a detailed record of which ones people have or haven’t received before, and when they received them, would be helpful.

Immigration status can also be a source of fear for migrant workers, since many are undocumented. Even though the organization I am working with this summer is a non-profit organization that is not affiliated with the government or immigration services, people still often give us false personal information such as phone numbers and date of birth. This can make it more difficult to communicate with them and keep accurate records.

There are a host of formidable language and cultural barriers as well. In both Costa Rica and the US, a number of the migrant workers speak indigenous languages as their primary language. Moreover, cultural differences may lead to provider and patient having different understandings of the causes of health and illness, the role of providers, and effective treatments.

These are but a few of the factors leading to the current health status of migrant workers. The average life expectancy of migrant farmworkers in the US is a shocking 49 years old (Moreno). Some of the health issues that have seemed of particular concern in migrant camps that we’ve visited this summer are diabetes and sexually-transmitted diseases.

Particularly with the tension surrounding immigration and migration in the US currently, people may wonder why they should care about migrant worker health. In my opinion, regardless of your views on immigration and what rights and services migrant workers should and shouldn’t be entitled to, health is pretty basic, and the people whose labor we benefit from at almost every meal deserve basic health. Moreover, migration is one example of how global health can easily become local.

There are a number of ways in which people who want to can contribute their energies and talents to help out. Recently, a group of college students at Evergreen State University held a bicycle collection drive, and we are in the process of taking the bikes to the migrant camps. Others volunteer to provide much-needed health education (see picture).

One thing I think would help the health status of migrant workers is reducing their invisibility in our society. Maybe I’m just ignorant, and other people are more aware of migrant worker issues than I was six months ago. But more media coverage, research, and people educating themselves would all help increase awareness. If you ever get the chance, visiting a migrant camp and sitting and having a conversation with the people there will affect the way you think about food.

Moreno, Alberto. Migrant Health Fact Sheet. Oregon Department of Human Services. Web. 4 July 2010. <http://oregon.gov/DHS/ph/omh/migrant/migranthealthfactsheet.pdf>.

I will first say that I had little autonomy of choosing which clinics I wanted to visit; the relationship was set up through a program facilitator and his previous connections. Actually, this ‘program facilitator’ was a retired doctor, Dr. Owusu, who remained on-call for any problems that our program’s students were having. One of the clinics he introduced to me was his own doing; he established the facility and served as the Medical Director for many decades until retirement. The other health facility - the one of which I will touch on in this article - is currently directed by a prior classmate and close friend. If given a choice, I would have preferred to also visit a more rural clinic; however, I was incredibly thankful for Dr. Owusu and his connections.

In this article, I will give a general overview of my experience at one of these clinics. I will discuss the methods of the doctor, the facilities available, and peculiar trends established by the patients. The Phillips Clinic was, obviously, a ‘clinic’ by definition and provided ambulatory, out-patient care on a daily basis. It was only open from 8-2 (or as early as the doctor arrived, usually around 7) and was best equipped to handle general, non-severe ailments. There was a single doctor’s office and a single doctor (Dr. Jane). About two or three nurses and two nurses-in-training were always present, plus the ‘matron’ who could dispense medicine. Additionally, about three men staffed the laboratory. Besides the doctor’s office - which contained the doctor’s desk and one check-up bed - there was a dressing room, a holding room, a pharmacy, a laboratory, and a waiting room. Sounds extensive - right? Let me embellish.

The waiting room held about twenty seats where patients would line up - first come first serve. The dressing room housed any equipment and supplies needed to dress common ailments like ulcers and burns. The pharmacy and laboratory were about equal in size - not over 10′ x 10′ each. The pharmacy was, to some extent, with medications with one wall lined with three filled shelves. The pharmacy was additionally the social hub of the staff. Most of the time, you could find several staff members, sitting in fold-up seats, talking amongst each other.

The laboratory was stocked with one microscope whose resolution and quality were about the grade of a typical high school’s microscope. With this piece of equipment they could diagnose malaria - a vital procedure here in Ghana. I was even able to see a parasite myself! Additional blood tests could be done by applying certain chemicals to the blood sample and reading the color of the solution. Patient’s blood was kept in open tubes and often not labeled. This was much unlike the security and sanitation measures taken in the US to ensure no mix-ups or contamination. There was a point in time when I was sitting in the laboratory and the lab tech spilled a drop of blood on the counter and simply wiped it away with a paper towel. Such measures would be ruled unsanitary and dangerous in the USA.

The waiting room at the Phillips Clinic. This is what you see immediately after entering the building.

Finally - the holding room was all of two hospital beds and maybe an IV. This room was never used in my time there but was present in case of a severely ill patient who would need to transported to a larger, 24-hour care facility after the clinic closed. Here’s my over-all summary of the facilities at the Phillips Clinic: Although the resources and facilities appeared minimal and rudimentary in comparison to standards set by the United States, it was my impression that the Phillips Clinic was a highly respected facility with loyal patrons.

I’ll speak more on Dr. Jane. Dr. Jane was the only doctor to practice at the Phillips Clinic. She received her secondary school education in what is arguably the best in Ghana - the Achimota School (originally the Prince of Wales School founded by British colonists). She moved to Germany for her medical degree and residency, and ever since has practiced family medicine in Ghana for 40-some-odd years. She is nearly 70 years old but always says she has plenty more years of practicing ahead of her. Dr. Jane always, always, emphasized the importance of a strong and cordial doctor-patient relationship. I observed this in her practice; she was kind to all individuals, greeting them with a smile, saying “happy new year” (despite it being March), and occasionally asking how their son/daughter/mother/father was if she had treated them before. From what Dr. Jane said, this mind-set - of showing kindness to patients- was not typical of doctors in Ghana. She asserted that many doctors were cold-shouldered and unsympathetic, they gave instructions of care without explanation of what ailed the patient. Patients don’t respond well to this attitude, she would tell me, when a patient feels demoralized and didn’t understand their condition, there was rarely motivation to change behaviors or faithfully administer the right medication. Dr. Jane was proud of the way patients trusted her and responded well to her advice. She even claimed that her most loyal patients have been with her for over 30 years and travel far beyond their means to meet with her. I was impressed by her approach to practicing medicine, especially because it follows the current trends in more developed countries, as far as encouraging bedside manner and a more egalitarian relationship than patriarchal one.

Dr. Jane seated at her desk with examination bed in the background. Patients would enter and sit at the chair next to her desk for consultations and moved to the examination bed only when necessary.

What surprised me the most was the ways in which my expectations were altered, with respect to the types of patients and the types of ailments they brought with them. When you think “Africa” or “third-world country,” what do you think? I thought about malaria and typhoid and yellow fever and malnutrition and HIV/AIDS and parasites, etc. What’s true about those expectations was that we saw a lot of malaria. To the point where, whenever a blood test was ordered, 95% of the time the doctor would check for parasites - just in case. Malaria symptoms are pretty general, fever, sweats, fatigue, and such symptoms don’t just apply to malaria. Additionally - a patient could come in complaining about a sore throat or respiratory infection but nonetheless, a malaria test would be conducted amongst other things especially because malaria weakens the immune system and is often the cause to secondary infections.

Another shot of the waiting room. The secretary's desk is in the foreground. The doctor's office is the door sighted on the left hand side. The dressing room, pharmacy, and lab are all located on the left-hand wall (not captured by this picture), across from the blue chairs.

What I didn’t see of which I expected to were the other conditions - typhoid, yellow fever, HIV, parasites, or even Hep B (half of these diseases required expensive vaccines to even be allowed into the country!). What I did see of which I wasn’t expecting were a whole lot of diabetes and high blood pressure. Wait, what? Diabetes? High blood pressure? Aren’t these the chronic diseases that affect Americans because we’re unhealthy, fat, and lazy? I explained my complexion to the doctor. And, of course, Dr. Jane had an answer:

A huge problem in Ghana isn’t necessarily undernutrition but malnutrition. There’s a slight difference. Undernutrition signifies the lack of sufficient calories. Malnutrition signifies the lack of a balanced and vitamin-rich diet. It was this malnutrition that led to such chronic diseases such as diabetes and high blood pressure. First off - a lot of Ghanaians drank soda. Bottled soda was nearly half the price of bottled water, about 50 cents a bottle. If they didn’t drink soda - they drank beer or malted beverages - still, both drinks that incorporated an incredible amount of sugars. Ghanaians would look at me weirdly when I refused a drink of soda. To them - it’s a source of energy so it must be good for them (It was also marked as being filled with ‘minerals’ and ‘nutritious’). Long story short - this chronic pattern of soda consumption contributed to high and growing rates of diabetes. And of course, it’s not the only aspect, but Dr. Jane truly believed that it was a contributor.

Furthermore, the Ghanaian diet didn’t incorporate too many vegetables or fruit. Not to say that these items were unavailable - but in relative price - were a lot more pricier than, say, a bowl of jollof rice or bean stew. The ‘poor man’s diet’ here consisted of very heavy fermented dough (made from maize, cassava, or plantains) with a heavy, tomato based stew.  The main diet was overwhelmingly based off carbohydrates and lacked nutritious items. Additionally - there was little nutrition awareness or education in schools so people didn’t know what proper nutrition included. These issues induced conditions that I had always associated with richer, more affluent nations whose diets are filled with high-fructose corn syrup, processed foods, and trans fats.

The pharmacy at the Phillips Clinic. If the in-house pharmacy did not have the proper medication in supply, patients would have to travel elsewhere.

Since there is a lack nutrition education within the primary schools, Dr. Jane’s advice to her patients seemed like common knowledge to me. Eat fruits and veggies five times a day, cut back on that palm oil (!), and watch your portions. She did her best to explain the causes of high blood pressure and diabetes in hopes to convince her patients that their health was in their hands. This tactic is, again, atypical of the “Ghanaian” mindset. Culturally, they accept a lot of events and conditions fatalistically; they saw themselves as not having control over unfortunate events and took it as it came. A common expression in any conversation was “it will come” signifies their belief in fate and a ‘if it’s meant to happen, it will happen’ type-of-attitude. I want to attribute this to the entire nation’s intense religiosity as they viewed themselves as vessels at the hands of their god; however, I only have anecdotal evidence for this so don’t take the previous statement as 100% fact. Anyway, this method of educating the patient is unorthodox since doctors in Ghana often just give direction and expect obedience. Dr. Jane recognized that a patient should be given information and should be informed of their role in maintaining their health. I observed that many of her patients were successful in stabilizing their blood sugar and lowering their blood pressure upon return. The patients who weren’t as successful often displayed their guilt when Dr. Jane gently chastised them for their elevated blood sugar or blood pressure. They acted in a way which indicated that they, logically, knew they were doing wrong but hadn’t made the personal choice to change their behaviors. I could imagine it’s often hard to do this, especially with a strong, culturally-enforced fatalistic attitude. In this case - Dr. Jane would, again, sit them down and describe more carefully how their health behaviors affect their body. It wasn’t a matter of prescribing the wrong dosage or the wrong medication, but informing the patient and connecting with them in a way that their behaviors changed.

Since the clinic was located in a middle class area of the city, we mostly saw local middle class citizens. Additionally, the pay-per-visit fee probably discriminated against lower class persons seeking help. There were certain companies and businesses whose insurance would pay for their clients’ personal visits; yet again, this signified that these patients were employed and had a relatively stable source of income (unlike a majority of the Ghanaian population). I walked into the clinic each week realizing that the patients diagnosed here, although representative of the Ghanaian population, was representative of a certain class of Ghanaians. I’m sure if I were located in the Northern Region, where health care is everything but available, that I would have seen a different incidence of disease.

Plenty more may be discussed about my experience in this clinic or even between the two clinics I visited. However, I will address these more specific topics in separate entries as to 1) keep the scope of this article limited to a ‘general overview’ and to 2) give myself more opportunities to embellish on my experience, without removing important aspects in sake of space. Hopefully, I have communicated the general sense of an ambulatory health clinic in middle-class, urban Ghana where the provision of care, although “different” from the health care we are used to in the United States, is impressive, organized, and patient-oriented.

A picture of the matron and me on duty.

A microbiology professor of mine, Amy Vollmer, believes in widespread science literacy, the idea that in the same way that everyone should know how to read, everyone should have basic knowledge about the way the natural world works. She believe that the importance of science literacy stems from the need for people to be able to act intelligently in making decisions in their everyday lives that affect the environment and life around them. Science literacy does not require a high level of scientific knowledge, merely a basic understanding of the natural sciences, and has the potential to improve global health.

To comprehend the implications of science literacy let us use the concept of an ecosystem. People should know about the delicate balance that exists in any ecosystem, which humans tamper with through their use of natural resources and waste disposal. Humans currently engage in over fishing, but perhaps they would be less likely to do so if those who engage in the act knew that dramatically reducing or wiping out a population of fish does more than just harm that species. It also puts in danger the organisms that depend on that species of fish for survival and gives an advantage to their prey, initiating a chain reaction of consequences for all the organisms in the ecosystem produced because the initial species’ prey and predators also interact with other living things in it. While perhaps obvious to those who are science inclined, this simplification of the effects of over-fishing serves to exemplify how people could become smarter in their actions with even a moderate level of scientific literacy.

The idea of scientific literacy is especially important with regards to health. Consider, the effective education campaigns conducted to combat malaria helped people make the connection between high levels of mosquitoes and the presence of stagnant water, which serves as their breeding grounds and should be drained to reduce mosquito numbers. Similarly, knowing that infection causing bacteria largely depend on a moist environment for survival can help people truly seize the importance of avoiding touching mucous openings (like the eyes, nose and mouth) with unwashed hands and increase the chance of people acting appropriately when sick. As these examples suggest, the possibilities for improved health are endless with increased scientific literacy, especially in the area of preventive medicine. If people have a better idea of how the body systems function and what causes infections (for example, what’s the difference between a virus and bacteria?), they have the tools to avoid behavior that will damage or put at risk their health. Improved literacy has been correlated to enhanced health (which, admittedly is perhaps in part a reflection of other underlying disadvantages of people with little education), but imagine what increased science literacy could do for improved health around the world in both highly developed and underdeveloped nations.

Image of server courtesy of Microsoft clip gallery; diagram courtesy of wikipedia commons

Even before I left for Ghana, this past January, malaria was on my mind. I didn’t have any parasites circulating in my bloodstream; however, I had begun taking my anti-malaria medication before entering the endemic zone. My drug cocktail of choice was Malarone – a combination of atovaquone and proguanil hydrochloride – meant to arrest the development of malaria parasites if, by chance, I was infected. Malarone and I would form a close relationship over the course of my four months studying abroad in Ghana – like a good ol’ friend. Like clockwork, I would wake up every morning and gulp down one of the small pink tabs after breakfast. Becoming so attached to my dear medication, I often experienced separation anxiety if I went traveling without it.

An advertisement for Malarone. From my experience, only travelers administered anti-malarials like this one. Ghanaians themselves would not pursue medication. Picture cited from dannysullivancopywriter.com

Here I was completely medicated and protected against a disease that infects 350-500 million cases annually, is responsible for killing between 1 and 3 million persons, and creates barriers to economic development. Additionally, I was traveling to the heart of its endemic sprawl – Sub Sahara Africa (SSA) - where nearly 90% of all malaria-related deaths occur. Ready – set – go.

I don’t know the exact moment when my perspective on malaria began to change and it might as well be that there was never a specific moment that instigated a change. What do I mean by change?

From my experience, all I’ve ever heard about malaria is the havoc it wreaks physically, socially, and economically, and the death that it incurs. From these statistics, I would assume it to be a disease of great danger and fortitude. Something of much greater magnitude than swine flu and definitely more than the common cold. But in the urban, university setting – malaria was perceived much differently than I expected.

There was a fatalistic attitude about malaria, especially if you were African (however, a few of my international friends adopted such mindset). You were going to get it. More than once “–” in a year. When you got it – there wouldn’t be a concern over life or death. There didn’t even seem to be much rush to get better. You would accept the fact that tiny little parasites are bursting out of your liver and swarming your bloodstream, call up the doctor (or not), buy some prophylaxis (either prescribed by the doctor or by yourself) and wait for symptoms to die down.

Sometimes, people skipped the ‘waiting’ part and got on with life. I remember I was at a rugby tournament when one of the players on the sidelines pointed to the referee and told me that he had malaria – meanwhile, this referee was on the field running in place and doing push ups during halftime.

Several of my Ghanaian friends would fall ill with malaria during the semester. Many international students did too, even when on medication. One of my closest friends succumbed to the toxic mosquito bite more than once. One of my economics professor lecture for a week because he fell ill. In the severest case, one classmate had to be hospitalized for three days, but this was after ignoring symptoms for over a week. Symptoms included full-body fatigue, fever, and nausea. If hit pretty severely, you would probably lie in bed for a couple of days recovering.

In my time spent at a suburban clinic and one of the largest hospitals in Ghana, malaria was THE most common cause of complaint. In the clinic, nearly every order for a blood test would include a test for malaria. It was in the doctor’s experience – the high rate of malaria prevalence – that it was more cost effective to test for malaria in nearly 80% of all patients than to test for other symptoms, only to find out it was malaria all along.

University students were privledged with a well-maintained, relatively sanitary environment near able health-care facilities.

If anything, malaria was even more widespread than the common cold. However, I don’t want to discount the magnitude of malaria’s infection or undermine any efforts trying to relieve the burden. First, let’s look at the situation and take note of the environment I surrounded myself with: I lived in an urban setting, close to medical and pharmaceutical facilities; most students had the financial means of buying treatment if needed; and most persons were relatively healthy, well-nourished individuals to start with. Plus, we were living in an environment where food was readily accessible, where water and electricity were provided with some reliability, and accommodation was more than adequate. Even with these advantages, productivity level of those infected with malaria was undoubtedly reduced. For us, losing productivity didn’t matter much. We were students, yes, who had to get to class. But in a worse case situation, we could siphon notes from a classmate.

Now, let’s take a step back. Let’s look at the average person in Sub-Sahara Africa:

- Life expectancy at birth is 46 years old;

- Infant mortality rates are double the global average

- 28% of children under 5-years-old are moderately or severely underweight;

- Only 36% are using adequate sanitation facilities

- 45% are living on less that USD$ 1 a day

- USD$611 is the average yearly income

One way to eradicate mosquito breeding sites but have access to potable water, espeically in the rural regions, was to maintain a capped water tub much like this one. Hazards did come with this method, though, as water was transported from local streams whose water-quality was unknown.

I think we can infer that the average university student (okay… above-average university student, in terms of socio-economic status and afforded living standards) is much more privileged and predisposed to healthier living conditions than the average Sub-Saharaian. When living in an isolate village, health care is hard to access and difficult to afford. Contracting malaria can be much more of a disability – or even a death threat – for those who don’t have adequate access to health care, proper levels of nutrition, and proper levels of sanitation. For a majority of SSA, these lacking factors are daily realities.

A key recognition is that malaria significantly affects the productivity of the nation. As I mentioned before it’s taken with varying degrees of disability. Some people power through the disease while others accept the fact they’re sick and take the time to rest. In these cases, they cannot work. If they cannot work, they cannot earn income. If no income is earned, sometimes, there is a question if enough food can be bought, etc. In this case, it has profound effects on the local economy of the poor. However, let’s say one of a wealthier class is afflicted. They can afford to miss a few days of work; of course it implicates their earned income, but they have enough to live money to live off without generating it on a daily basis. Here is another reason why we can say malaria discriminates. Those who it hits the hardest, those who can’t protect themselves nearly as well, those who can’t afford to treat it – these are the persons who are also the ones who can’t afford to live with it. When teetering on the threshold of non-poverty and poverty, one bout of malaria can quickly sink a family into such a state.

It is villages like these, in the largely-ignored Northern Region, that feel the greatest burden from malaria-caused symptoms.

Therefore, I would like to suggest that it is the discriminatory nature of malaria that transforms it into threatening disease. It doesn’t have to be a threat. It certainly isn’t in the upper echelons of society, but it certainly is in the majority of the populace. This proves a challenge because these same people also lack political power and institutional power; how can they advocate for their health without a strong voice? We must recognize this key disparity between socio-economic classes and influence policy to address these issues. Although such diseases may just be nagging pains for the well off, it can be an affliction of much greater magnitude for the majority of the population.

Conclusion: Malaria is much more common than I thought, and for some, much less severe than originally perceived. It is approached in a fatalistic attitude. It reduces the productivity of daily life in varying degrees. My observations derive from relatively upper-end living arrangement and lack evidence from less-privileged, or even ‘average,’ Sub-Saharaians. Research focusing on the prevention and eradication of the disease is compulsory to improve the social well-being of Sub Saharan Africa.

Data cited from UNDP and UN Health Reports.

We encountered a wide range of knowledge about dengue, from people who knew nothing about the disease to people who had had the disease several times and could name the exact species of mosquito (Aedes aegypti), its preferred breeding sites (stagnant, clean water), and the symptoms of the disease (fever, myalgias, retro-ocular pain).

Sometimes this knowledge was put into practice, and sometimes it was not. While many people had turned over boots and buckets to prevent water from accumulating and mosquitos from breeding, coconut shells and leaves were often overlooked as potential breeding sites. In addition, drainage systems were often inadequate, allowing for puddles to form.

I appreciated that the health system in Costa Rica sends people door-to-door to discuss health issues with the population. In many ways, the Costa Rican health system emphasizes preventative healthcare and bringing services to the people.

We hiked to this health outpost in a rural area. Among the challenges to  delivery and access of care were its remote location—we had to hike through a forest along winding paths, and I could only imagine how much worse it would be during the wet season. Equipment and vaccines had to be carried between health posts. Some linguistic and cultural barriers also seemed to exist, since many of the patients were indigenous. In the face of such challenges, I was impressed at the extent to which healthcare providers really worked to bring the healthcare to people, such as the willingness of the doctor to travel to the health post, or the willingness of the technicians to carry the vaccines out in coolers.

An urban community in which we performed health outreach had different issues. In contrast to how remote and spread out the rural community was, the urban community was extremely overcrowded, with people cramped into rickety houses, and narrow alleyways full of stray dogs and trash. Challenges to healthcare delivery and access included immigration status and lack of knowledge about resources, as well as poverty. We had the opportunity to work with a great non-profit that provides free medical care to children there. They have a website if anyone wants to check it out:  http://www.cwbfoundation.org/

Harmful.

Courtesy of KleinPictures

Those are the adjectives the Klein family uses to describe much of the aid that goes to the African continent. Their documentary What Are We Doing Here? traces the journey of three brother and a cousin who travel for 6 months from Cairo to Cape Town, talking to NGO workers to child to parents to government officials, to learn about charity in Africa.  We were lucky, at Swarthmore College, to have Tim Klein present his film on January 22, 2010 to an audience of over 200 people and answer questions from the audience after the showing.

The film and the event Swarthmore’s Global Health Forum helped Americans for Informed Democracy organize were created to spark discussion about foreign aid.  As the film asks, why has the situation in so many places that receive aid not improved? Wouldn’t you expect that aid should alleviate the poverty it targets?  The film shows that there are various answers for why much of the aid has not helped.  Moreover, it illustrates how aid is often harmful.

Here are some key and disconcerting points the film makes:

Aid to Africa is a multibillion dollar industry. The rice that serves as food aid comes from U.S. farmers, so it hurts farmers in African countries who cannot compete and who themselves become dependent.  As one man says in the film, “What has been accomplished has been to effectively put many African countries on a life support system.”  Much of the foreign aid does nothing to help people in the continent help themselves.  That is the main problem.

When you sponsor a child, that money does not actually go to a child.  Rather, the money goes to building programs and longer term initiatives that will improve children’s lives and futures.  In principal, that use of money is actually more beneficial than giving the money just to one child.  Why do organizations have to misled people to get money?  Why isn’t it understood that true aid means helping people help themselves?

Another problem, the film argues, is that governments are not held accountable by their people.  The relationship between government and people is often non-existent.  People go to aid organizations directly instead of to their governments.  State building where the government acts for the people is not happening.  Aid organizations are not helping either, because they serve an inappropriate role as intermediaries between the government and the people.  Sometimes, as in the case of the Rwandan genocide, they even give aid to people who are harming others.

Some Africans think the best thing is for other countries to leave them alone.

For me personally, watching this movie and seeing the beautiful lush land on the continent really drove home the idea that external interference has been harmful.  Its not a coincidence that with so many natural resources the poverty continues.

We need to change the way aid works.  To join in on these efforts, obtain the movie, or to learn more visit www.whatarewedoinghere.net.

The week of February 7-14, 2010 is Minus Malaria Week.  Swarthmore College’s GHF is spearheading this week of college students coming together to support the eradication of the burden of malaria.

$5,000, the equivalent of 1,000 bednets

Students participating in Minus Malaria Week will do this in three ways: education, fundraising, and advocacy. Student organizations in support of the Minus Malaria Initiative (MMI) will host both an educational campaign and a fundraising campaign on their college campus.  Through their campaigns, organizations will work to raise awareness about malaria in their communities and to advocate for malaria relief by participating in the Give a Net, Get a Vote campaign: for every $5 donated (the equivalent of one net), supporters of MMI will have the opportunity to sign a letter to Congress, expressing support for legislation that furthers the goals of MMI.  All funds raised will be used to purchase bednets to be distributed in Malen chiefdom in Sierra Leone, a community where MMI has previously focused its efforts.

Interested in joining? We’ll provided extensive support to all individuals and groups interested in participating, including toolkits, help with planning, materials, event ideas, etc.  Participation take the form of a small scale event that serves the two-fold purpose of fundraising and educating or it can be a week long series of events.

Contact Cariad Chester at cariad.chester@globalhealthforum.org and John McMinn at john.mcminn@globalhealthforum.org to join!  Visit “For Students” section (link above right) for more information and click “Partner With Us”.