One Health working will improve health and well-being of us all: plant, animal, human and ecosystem!

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    Pastoralists, Mongolia. Image courtesy of Esther Schelling, Swiss TPH.

 One of a series of blogs written by CABI editors for One Health Day on November 3rd 2016
 
It's always nice to meet up with a CABI author at a conference especially when they are giving a talk around a theme dear to CABI‘s heart,  namely “One Health”: the concept of working across the interface of animal, plant, human  and environment  to achieve health  & development  which is sustainable and fair. CABI has been gathering, managing and generating research information across all these sectors since 1912.  We know “its all connected”.

The conference was the RSTMH biennial meeting [Cambridge UK, Sept 12-16th, 2016], and the author in question, Esther Schelling, co-editor  of CABI’s  book One Health: The Theory and Practice of Integrated Health Approaches [2015].    To read a  free e-chapter, use this link.

In One Health beyond early detection and control of zoonoses Esther talked about her long-time project with nomadic pastoralists in Chad and a rift valley fever (RVF) control project in Kenya.  She drew attention to the need for:

  • more interdisciplinary studies to include an evaluation of One Health working
  • involvement of social scientists
  • engagement of key stakeholders

And tellingly she provided a cost-benefit analysis to society of controlling zoonoses when the disease is in its animal host before it infects human beings. 

Those cost-benefit analyses made a deep impression on the delegates, many of whom were involved in zoonotic neglected tropical diseases. Perhaps for the first time they were appreciating the added benefits and synergies that a transdisciplinary approach between science, society, humanities and medicine could bring.

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Different explanations of mental illness in Jamaica: can we combine the traditional and biomedical to heal body and spirit?

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Gordon Town Health Centre, Kingston, Jamaica. Image: H. Schwartz

Today is World Mental Health Day [October 10th 2016], whose theme is "psychological first aid and the support people can provide to those in distress". An apt moment to publish the insights into Jamaican community mental health of our summer intern, Harpur Schwartz. In her opinion piece below, Harpur addresses the role of traditional health beliefs in expressing mental distress, and identifies a role for traditional medicine in supporting recovery.

Have you been hearing any voices by Harpur Schwartz, edited by Wendie Norris

I could barely make out his answer to the question, “Have you been hearing any voices”, as he was speaking an English based creole language commonly known as Patwa. From what I could understand, spirits come to him during the night and tell him the ‘truth’ of the world around him. He said that his madness was caused by a spirit or Obeah. It was clear that this man had a mental illness that he strongly believed was caused by supernatural factors. The psychiatrist in the room asked patient number 23, “But you understand these voices are not real, right?” His response was “Yes”. Satisfied with his answer, the psychiatrist administered his medicine and handed him his appointment card without a second thought.

While working with the mental health services unit at the Gordon Town Health Centre in Kingston, I noticed a pattern to each patient’s appointment: the patient would be called in by number, he or she would be asked a series of questions about mood and symptoms, an injection of medicine was always administered, and the patient would leave with an appointment card stating the date for when he or she should return the following month. There was a rhythm to this process, one with emphasis placed on drug administration.

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Why Latin America is nearer elimination of rabies than Africa

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"World Rabies Day" is September 28th. Copyright: CC, Global Alliance for Rabies Control   
   
Rabies: a contagious and fatal viral disease of dogs and other mammals, transmissible through the saliva to humans and causing madness and convulsions. Rabies is fatal once symptoms appear.

Latin America is doing far better at managing, controlling and ultimately eliminating rabies from the region. Africa is failing to make the same gains and a rethink is required: can the lessons learned in Latin America be  applied or adapted to Africa?

At  the biennial RSTMH meeting “Challenges in Disease Elimination” held in Cambridge [September 12-16th, 2016], Katie Hampson [University of Glasgow] described the Pan American Health Organisation (PAHO)'s surveillance & management framework operating in Mexico and Brazil,  and devised to support the elimination of rabies in 25 PAHO countries. She also described the work of Tanzanian colleagues who have developed a “pragmatic approach to surveillance” for the African setting where resources are constrained.

Current situation of rabies control in Latin America vs Africa

The short answer is that in Latin America, PAHO, which exists to “strengthen national and local health systems and improve the health of the peoples of the Americas”, has concentrated on vaccinating the dog population against rabies and interrupting transmission. African countries have no similar regional support structure for their health ministries and rely on post-exposure prophylaxis (PEP)  of humans bitten by dogs, to achieve a form of control of rabies. PEP vaccination only saves lives if the bitten person has timely access to a well-stocked clinic, and the money to pay for the shots. In remote and rural areas, this can lead to grim choices: which child do you treat if you only have money for one?  We heard at the RSTMH of an African mother with several children bitten by the “family dog”, who having travelled a great distance to reach the vaccine, was then faced with that very choice.

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The recognition of Mycetoma: much needed attention finally given to long neglected tropical disease (NTD)

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Image: Woman in the West Indies with mycetoma caused by a fungal organism
CDC/ Dr. Lucille K. Georg

From Harpur Schwartz, an economics/global health student from Connecticut College, USA,  interning with Cabi’s Global Health team.

While tuning in to the live broadcast of the Sixty-ninth World Health Assembly taking place at the World Health Organization (WHO) headquarters in Geneva, Switzerland, mycetoma reached the discussion floor. At the risk of sounding naïve, I’m going to tell you that I had never heard of mycetoma – although a quick google search revealed images resembling elephantiasis. As a student studying global health, I was a little disappointed with myself; I mean I have at least heard of the other neglected tropical diseases (NTDs). But if mycetoma was unfamiliar to me, how many other people had never heard of this disease? I have provided answers to some basic questions I had about mycetoma in case you too are unfamiliar with this disease…

What is mycetoma?

The World health Organization describes mycetoma as, “… a chronic, progressively destructive morbid inflammatory disease usually of the foot but any part of the body can be affected”. This disease is caused by a bacterial (actinomycetoma) or fungal (eumycetoma) infection where the organism enters the body through a minor trauma or a penetrating injury (i.e. commonly a thorn prick). It is believed that the infection enters the body after this pricking occurs, but there are no concrete studies determining transmission. A good video on it can be found here in Global Health Now's Spotlight on Mycetoma by Amy Maxmen.

Is there a cure?

In terms of treatment, curing actinomycetoma using antibiotics has about a 90% success rate. The use of antifungals to treat eumycetoma has a success rate of about 35%, but in 2016 a new antifungal agent, fosravuconazole, will be the subject of the First Clinical Trial in Mycetoma conducted by Drugs for Neglected Diseases Institute (DNDi). Because the disease takes a slow, relatively pain-free progression, mycetoma is at its most advanced stages once it is diagnosed. It is at these later stages when amputation becomes necessary.

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Blood donation in post-Ebola West Africa

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Copyright: James Meiring. Winner HIFA Photography award 2016

What do wellington boots drying in the African sun have to do with blood donation in the post-Ebola era? Tell you later.

But first, as its World Blood Donor Day on June 14th, lets consider the differences between the blood transfusion services in a high income country like the UK with those in Nigeria or Sierra Leone? How has the Ebola epidemic impacted on these services?  

Blood transfusion services in the UK

I think we in the UK probably take our well-established national blood service(s) somewhat for granted and only really give it a second thought when either we need to call on its use or something drastic goes wrong.

Established in 1946, the Blood Transfusion Service (BTS) in England and Wales employs over 6000 people to collect & process the blood alone. All sorts of rules and practices surround the preparation and distribution and use of that blood. We are very fortunate that over 3% of people in the UK donate that blood (1% being the figure recommended as a minimum by the W.H.O. to meet a populations needs) but even then we get regular appeals for more blood and we still suffer shortages for particular blood groups and platelets.

But, have you ever asked yourself why we need continuing fresh donations of blood and who are the usual recipients of that blood?

In 2014, in England & Wales, the 3 major “consumers” of blood were:

  • 67%, to treat medical conditions including anaemia, cancer and blood disorders
  • 27%, in surgery, including cardiac surgery and emergency surgery
  • 6%,   to treat blood loss after childbirth

The most frequently transfused patient group is over 65 years of age.

100% of the blood donated is voluntary. This is important, as the W.H.O. has declared that the foundation of a safe blood supply is 100% voluntary donation. Blood obtained this way has lower rates of infections and so reduces chances of disease transmission via blood or blood products.

How does this compare with a blood transfusion service in West Africa ?

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Finding a balance between equality and safety in blood donation: the 12 month ban for MSM donors

 Blood-732297_1280 image: Give Blood.
creative commons CCO

Our guest blogger this month is Harpur Schwartz, an economics/global health student from Connecticut College, USA.  Harpur is interning with Cabi’s Global Health team, learning how information resources can support public health education programmes.

World Blood Donor Day 2016 [June 14th] is quickly approaching, and this year’s theme will be “Blood connects us all”. The goal is to motivate regular blood donors to continue to give blood while motivating new blood donors to start by showing how patients and donors are connected. With the current blood donation crisis, the worry is people do not understand that they qualify to donate. To clear up any blood donation confusion, many countries like the UK have provided specific guidelines [blood donation rules] for who can give blood. Donors have to wait only four months after getting a tattoo or piercing to give blood and a mother only must wait six months after giving birth. Gay and bisexual men [men who have sex with men] who used to face a lifetime ban in the UK, can donate blood if they have not had sex with another man for at least 12 months. This 12 month rule came into force in 2011 in the UK but has only recently done so in the USA (December 21st 2015, FDA revises donor deferral guidelines). It is the reason why many people in Orlando USA, anxious to donate blood to help their injured friends, are not able to do so (Gay Blood Donation Ban Under Fire in Wake of Orlando Shooting).

I have always been interested in how society is responsible for defining disease, and how once a person is labeled as having a certain disease, it frames their very being. In one of my university classes, we discussed how ‘Disease as framed’ is the way in which a person’s image changes as a result of disease. The example we discussed was AIDS and gay men. With the current blood donation policy, my question is if gay men are still being discriminated against because of their association with HIV and AIDS, or if the policy is based on sound evidence?

There has always been a stigma attached to the gay population in regards to HIV and AIDS, mainly because this was where the disease was first identified. [The story of the discovery of the AIDS epidemic is chronicled in the 1993 film “And the Band Played On”. Attitudes began to change in the USA when Mary Fisher delivered her speech, “A Whisper of AIDS”, at the Republican National Convention that took place in Houston in 1992. As a white female, and mother of two, Mary became a new face for HIV and AIDS. She was not a haemophiliac, she was not gay, she did not inject drugs, and yet she still tested HIV positive. Fisher explained to the world how “…HIV asks only one thing of those it attacks. Are you human?”

The gay and bisexual community are still unhappy with being treated differently. A 12 month ban does not take into account if they practiced safe sex, or have been in a committed relationship for 10 years with the same man. However, the 12 month ban policy is based on research evidence and is supported by numerous countries including the UK, the US, and Australia.

 

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Traffic congestion causes hotspots of air pollution and road traffic accidents

Road traffic holdups reduce air quality and increase risk of accidents

Traffic congestion is a public health issue. It increases air pollution which is a known cause of asthma, lung cancer and cardiovascular diseases, and in particular creates "hotspots" of low air quality borne by local residents.  It increases the risk of traffic accidents through poor driver behaviour and judgement.

One morning last week, I was stuck in a traffic jam several miles long on the A40 outside Oxford, caused by the super-duper high-flow-thru roundabout at Headington being brought to a halt by roadworks eliminating one lane on one exit and a traffic light failing on another!

Those of you who commute to Oxford will pick up my ironic tone: we have had to endure doubling of commuting times & traffic jams for the past 2 years as Oxford has “improved” each roundabout by turn around the ring road!

Philosophical (I wasn’t going anywhere fast), I found myself wishing the clock turned back to a time when most people lived and worked in the same town, and then I moved on to wishing for a reality where “pass me the floo powder and where is the nearest fireplace?”[Harry Potter], or “beam me up scotty!” [Star Trek]  were actual options. These options would improve my quality of life, my health, and my climate. And of course everyone else’s.

It was also not lost on me, in that traffic jam, that this month [March 2016] my colleague and I had made Air Pollution the theme for our free electronic public health newsletter (to receive this, sign up here Global Health Knowledge Base).

I had just written a blog on air pollution caused by traffic jams in India, China, and why it’s the particulates, released by soot & fuel, that we measure for air quality & health. In the blog, Air pollution, can we reduce the impact of cars on urban air quality? , I had hoped that  emerging economies were going to learn from the mistakes of the UK and other “developed” countries. And there I was in the mistake.

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