Because of my own experience growing up in a rural Colombian community with the constant threat of contracting a parasitic infection, I knew that as an adult, I would do as much as I could to help improve the lives of children growing up in communities similar to mine. I recently joined a one-week public health humanitarian mission with Global Brigades, a nonprofit global health organization, where we worked to better the living conditions of a rural community in Honduras named Joyas del Carballo.

The Global Bridge Group!

My objectives during this trip were to identify any deworming activities and the impact of NTD control within this area, and to provide at least one family with the basic tools they need to live healthier lives in order to avoid the threat of parasitic infections.

After a week of hard work, our brigade had built a latrine, a basin for clean water, a heat efficient stove, and poured concrete over dirt floors in Don Gregorio’s home. With these new additions, his grandchildren, Hector and Catherin, will grow up free of soil-transmitted parasites. They will be able to use a clean latrine, bathe on a daily basis, and wash their hands before eating. They will be able to thrive and excel in school and to come that much closer to escaping poverty.

Their lives have changed forever.

We also visited Jose Rivera Paz Rural School, a grade school comprising of students aged 6-13 years. There, we watched a play that the students had prepared for our group. The play was an opportunity for the students to demonstrate what they have learned from community health educators and other Brigade groups, such as the benefits of the medical and public health brigades in the community. The play also included a re-enactment of a deworming activity. I spoke with one of the school’s teachers, Dora, who was funnily enough standing by a large poster of “Dora the Explorer.” She thanked us for the work we were doing in her community and then introduced us to all of her students.

Student holding up a bottle of Albendazole, used to treat intestinal worm infections

Dora also has an instrumental role in protecting her students from NTDs. She ensures that her students are treated every six months with deworming medicines supplied by the groups sent by Global Brigades.  She documents the names of children who receive treatment along with the type of drug they are receiving, then reports the numbers to the local health center.

Most of the students at this school are a part of families that have gotten new floors, stoves, water basins, and latrines through the efforts of Global Brigades. These changes within their homes and regular deworming campaigns at the school will sustain a strong new generation, one free of parasites.

Hector, Catherin, and the students at Jose Rivera Paz Rural School are all living proof of sustainable public health interventions that have been carried out by Global Brigade groups.

I plan to return to Honduras on the next Brigade to visit Hector and Catherin at their new improved home to see the impact of our project.

Manuel Claros, winner of the individual Campus Challenge, is a graduate student at GW School of Public Health MPH Global Health policy.  He is a foreign medical graduate from Colombia  with 10 years of experience in HIV prevention and education. He enjoys photography, going to the movies, traveling and cooking.

P.S.  More pictures from Manuel’s trip to come!

1. The Global Network got an awesome opportunity to showcase a 15 second spot on the CBS Superscreen in New York City! Check out the video and join Alyssa Milano and Text “LIFE” to 30644 to End The Neglect!
2. Our wonderful communications/grassroots intern Linda shared her experience in  Honduras as a student volunteer working on construction projects for impovrished communities.
3. We got a little clinical when discussing Lymphatic Filariasis in our second “Worm of the Week” installment.
4. We got excited about the 30th anniversary of smallpox eradication!
5. Alanna Shaikh talked sandflies and giant sores, with a great article on  leishmaniasis, a horrific neglected tropical disease threatening 350 million men, women and children in 88 countries!
6. The Bill & Melinda Gates Foundation also had some great articles about smallpox this week, so we were excited to reprint them here for your reading pleasure!

By: Dr. Tadataka Tachi Yamada

When I was growing up in Japan, my close friend Keichi Maruyama, who lived right next door to me, was crippled from polio.

Most people today are too young to remember, but it was a disease that struck fear into every family. We knew it could hit home at any time.

Dr. Tadataka Tachi Yamada watches as a boy receives a polio vaccination at Bhairon Mandir Temple. Tachi was there to understand the importance of transit and migratory populations in contributing to polio transmission. New Delhi, India. April 5, 2009. Photo courtesy of the Bill & Melinda Gates Foundation / Prashant Panjiar.

Polio is no longer a threat in most of the world, thanks to a polio vaccine and an enormous global commitment. We are now locked in a mortal battle to completely eradicate the disease and have reduced the fight to just four countries – Nigeria, India, Afghanistan, and Pakistan.

This week I attended a symposium to commemorate the 30th anniversary of smallpox eradication. Thanks to the development and delivery of a vaccine, we achieved one of the greatest global health victories of all time. Vaccines are the most important and cost-effective intervention available to prevent illnesses and death.

I believe the fundamental lessons from smallpox can be applied to many diseases, especially the fight against polio. We need political will, sufficient human and financial resources, and ongoing scientific innovation

Of course there will be challenges along the way. I think the biggest lesson from the smallpox success is that we must approach each new challenge with the spirit of continuous learning and be flexible enough to adjust along the way. We must do the same until the world is polio-free, so that our children’s children will never have to say: “You came this close and gave up.”

Dr. Tachi Yamada, president of the foundation’s Global Health Program, leads the foundation’s efforts to help develop and deliver low-cost, life-saving health tools for the developing world. He oversees Global Health’s grantmaking, which focuses on four major activities: discovery, development, delivery, and advocacy.

It was recently pointed out to me that I’ve never covered leishmaniasis in my posts. I’d hate to make an NTD extra-neglected, so I’ll look at it today. As a quick refresher, you may recall that I named it “giant sores and organ damage disease” in my very first post on this blog. It’s also known as kala-azar.

For a somewhat more formal description of leishmaniasis, we can turn to the World Health Organization (WHO). They’re just issued an information page on the disease. (Which, by the way, is good news. It will help raise the profile of this NTD and all the others as well.) The WHO would like you to know that:

Leishmaniasis is caused by protozoan parasites belonging to the genus Leishmania. The parasites are transmitted by the bite of a tiny – only 2–3 mm long – insect vector, the phlebotomine sandfly.

Photo Credit: CDC

I think they’re kind of burying the lede there. I don’t honestly care about the length of the sandfly that transmits the parasite that causes the huge sores. (Though, on a personal note, sandflies bit the heck out of me last summer and I spent many insomniac hours worrying about leishmaniasis. Working in global health is not always good for the psyche. And I googled; we do have leishmaniasis in Tajikistan, although not in terrible amounts. It’s genetically unique.) They also suggest you watch the trailer of a film on the disease.

If you scroll down the page a little more, here’s the numbers that made an impact on me:

Leishmaniasis threatens about 350 million men, women and children in 88 countries around the world. As many as 12 million people are believed to be currently infected, with about 1–2 million estimated new cases occurring every year.

88 countries (including Tajikistan) is an awful lot of territory. And the WHO page doesn’t get into leishmaniasis control at all. Once you tell me 12 million people have the disease, and 2 million more every year, I want to know how to stop the thing. The WHO does have a leishmaniasis control page, with their chosen five points for fighting the disease (my thoughts in parentheses):

• Facilitation of early diagnosis and prompt treatment (Helps both the people who get treated and keeps them from being a reservoir for the disease.)
• Support for control of sandfly populations through residual insecticide spraying of houses and use of insecticide-impregnated bednets (I wonder if they use the same insecticides used for mosquito spraying? I am going to assume yes, otherwise the bednets situation would be ridiculous.)
• Provision of health education and production of training materials; (What are people being educated on? I guess bednets and spraying and why sandflies are bad.)
• Detection and containment of epidemics in the early stages (Not quite sure how this is different from the first point. I guess it’s based on looking at data at the population level and requires support to government bodies on data collection, as opposed to training individual health care providers.)
• Early diagnosis and effective management of leishmaniasis/HIV co-infections. (That had never even occurred to me – leishmaniasis and HIV. Makes sense though.)

I think the WHO is missing one more tool to fighting leishmaniasis, and all NTDs: poverty reduction. The NTDs are still fundamentally diseases of the poor. Less poverty will mean fewer infections. It’s not exactly the WHO’s field, I admit, but it’s worth pointing out.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not neccesarily the views and opinions of the Global Network.

By: Walt Orenstein

I will never forget March 16, 1975.  It had been almost four months since I began working in India’s largest state, Uttar Pradesh (UP), to try to eradicate smallpox. 

On that morning, I was contacted about a new case of smallpox.  I reached the patient about 1 ½ hours after she died from an unusual complication, late hemorrhagic smallpox.  Her name was Shanti, a 7 month old child, the daughter of Pyari Lal. She was probably infected by her sibling.  Her death was totally preventable, but fortunately she turned out to be the last case of smallpox in UP.

We finally broke the human chains of transmission of that terrible virus.  That experience in India taught me how serious vaccine preventable diseases could be and how powerful vaccines are in preventing these types of tragedies.

Walter A. Orenstein, M.D doing community outreach in Aligarh, Uttar Pradesh, India during the successful 1975 smallpox eradication campaign. Photo Credit: Bill & Melinda Gates Foundation

The eradication of smallpox showed that effective vaccines can lead to the ultimate goal: the permanent end of a serious affliction of humankind. Smallpox eradication is our generation’s gift to all future generations.

Polio is the next vaccine-preventable disease targeted for eradication. This terrible disease causes severe, life- long, crippling illness.

As a child, growing up in the United States during the 1950s before polio vaccines were available, I remember the fear and panic that spread through the community at the height of the summer-fall epidemics.

With effective polio vaccines, we eliminated the disease in all of North and South America. Europe and major sections of East Asia have also been certified as polio free. Now, we have the opportunity to finish the job.

Many of the lessons learned from smallpox eradication have been applied to today’s polio efforts. Using a strategy tailored to the specific vaccine coupled with finding and investigating each individual case are critical for success. They also help to measure progress, inform adjusting tactics and identifying the need for continued research to develop new tools to achieve eradication.

The world is very close to being polio free–there has been a 99 percent reduction in cases, compared to when the eradication effort started. We have reduced the number of countries in which polio is endemic from 125 to 4.

_____________________________________________________________________________________________________________

Editor’s Note:  The Global Network for Neglected Tropical Diseases is a major initiative of The Sabin Vaccine Institute. The Sabin Vaccine Institute is proud to convene, along with Fundação Oswaldo Cruz and the Fogarty International Center, a symposium to commemorate the 30th anniversary of smallpox eradication. “Smallpox Eradication after 30 years: Lessons, Legacies and Innovations” will be held August 24-27, 2010 in Rio de Janeiro, Brazil.  Watch a live stream of the SEC 2010 smallpox symposium here. The feed will be available from 5 PM EST August 24, 2010 through 12:30 PM EST August 27, 2010. Please check the agenda for more information.

We have some exciting news to share with you! The Global Network for Neglected Tropical Diseases was given the exciting opportunity to showcase a short video on the CBS Super Screen in bustling New York City’s Times Square. The video will run for 15 seconds of every hour, 18 hours a day for 60 days —receiving in excess of 1.5 million viewers daily!

Take a look at the video below (also embedded in the sidebar on the right) and join our Global Network Ambassador Alyssa Milano by texting “LIFE” to 30644 to learn more on how you can help End the Neglect.

www.youtube.com/watch?v=qZwS9DpTSXM

P.S.  If you happen to be in New York, wandering through Times Square (particularly on 42nd St. between 7th and 8th Ave)  and see our video on the CBS Super Screen , take a photo, send it in and we’ll post it!

Meet the Velasquez-Medina family: Gregorio Velasquez and Anastasia Medina live in a small two-room home with their two adult children, Carla and Oscar, and their two small grandchildren, Hector and Catherin, in rural Joyas del Carballo, Honduras.

The Velasquez-Medinas is one of the poorest families in their small community, living on $5 a day, lacking basic necessities such as clean water, and going without food on most days. There are many families living in these impoverished conditions throughout Honduras and the world; fortunately, there are organizations such as Global Brigades who work in developing countries and serve families just like the Velasquez-Medina family. Global Brigades is a 501c3 nonprofit organization working to mobilize student volunteers to help provide individuals in Honduras and Panama with a better quality of life through economic, public health, medical, and infrastructure assistance. This summer, I and Campus Challenge winner Manuel Claros, were fortunate enough to participate in a Public Health Brigade – a week-long trip where student volunteers work to improve living conditions for an assigned family – to Joyas del Carballo, Honduras. We worked on four construction projects in efforts to help provide the Velasquez-Medina family with a better quality of life.

Meeting the family for the first time

We landed in the city of Tegucigalpa, the capital of Honduras, on August 7, 2010. We then took a two hour drive to the traditional hacienda-style compound where we would reside for the next week. In the coming days, we met the Velasquez-Medina family and began work straight-away on four construction projects: 1.) building a latrine, 2.) cementing dirt floors, 3.) constructing a pila or basin for water storage, and 4.) deconstructing the current stove so smoke would funnel out of the house safely. The purpose of these projects was to provide sustainable solutions to health problems experienced by the family – such as asthma from inhaling smoke from cooking and diarrhea from contaminated drinking water – and also to prevent the spread of disease.

One of the greatest lessons that I took away from my time with the Velaquez-Medina family was that you don’t need much in life to be happy. As we were sitting on buckets in the family’s small haphazard kitchen with no electricity and floors made of dirt, Anastasia and Carla were cracking jokes, and Gregorio was talking about how privileged he felt to be provided with some of life’s basic necessities. The contentment with what very little they had was humbling, leading us all to evaluate our own lives and priorities.

Working on the pila

On our itinerary, we were scheduled to work on our projects for the Velasquez-Medina family Monday-Wednesday. Each morning, we woke up at 6:00am and made the two hour drive on unpaved, bumpy roads to our work site, the family’s home. For three days, we built the latrine, cemented the dirt floors, constructed the pila, and re-built the stove all by hand. The work was labor-intensive and physically draining, however, knowing that these projects would serve as sustainable solutions to many of the health issues that this and other families in the community are faced with on a daily basis was our motivation. All of us were also inspired by the drive and hard work that the head of the household Gregorio Velasquez was putting into each project. He had a hand in every single aspect of construction, and never stopped to take a break. And even though he was 66 years old, which is the average retirement age for many Americans, he was still able to carry an 80 pound bag of dry cement down a steep hill, all in efforts to provide a better life for his family.

Although members of the family have not been diagnosed with parasites, many children within the community suffer from NTDs. Another student group from London who was on a Medical Brigade observed that a large portion of the community were infected with intestinal worms(which was evident by swollen bellies), and witnessed community drug distributors distributing albendozole – a drug used to treat roundworm, whipworm, and tapeworm – at a local community center. The medical students mentioned that this type of drug distribution usually occurs via the aid of a Global Brigade group.

This was confirmed when our group visited a nearby school. Manuel asked one of the teachers about school-wide deworming initiatives. The teacher informed us that deworming in that particular school occurs every six months, and drugs are given by Global Brigade groups. This deworming is not mandated by the school system; rather the faculty took it upon themselves to actively get their students dewormed on a regular basis. Documentation of deworming is then reported to the local health department.

There are many communities such as Joyas del Carballo that rely on the services and advocacy provided by organizations such as Global Brigades. Please visit the Global Brigades website to join a brigade, and also stop by the Global Network website to join the fight against NTDs.

To view all my photos from the Brigade, including before and after pictures of the home, please visit our Flickr page.

By: Nathaniel Wolf, Sabin Vaccine Institute

August 20^th is World Mosquito Day.  In 1897, Sir Ronald Ross looked at a mosquito under a microscope and saw that it looked really cool up close.  He declared August 20^th World Mosquito Day and said we should be nice to mosquitoes, if only one day a year. 

Not really.  What Dr. Ross discovered was the link between mosquitoes and transmission of malaria.  He declared World Mosquito Day so that people would become educated about the life cycle of malaria, and in 1902 he won the Nobel Prize in Medicine for it.   In spite of this discovery, today the disease continues to be a threat to approximately 2.85 billion people, afflicting 250 million people around the world and causing an estimated 1 million deaths annually.   

Dr. Ross’ discovery was made possible by another discovery some 20 years prior.  In China, Sir Patrick Manson discovered that the mosquito is a vector for lymphatic filiariasis (LF), a debilitating parasitic disease that currently afflicts about 120 million people around the world.   LF causes a range of symptoms including elephantiasis, hydrocele and extreme swelling of the scrotum.  The economic and social effects of this disease are enormous.  If you’ve ever read James Michener’s Tales of the South Pacific, wherein he talks about a man who, in order to walk, had to push before him a “rude wheelbarrow” in which “rested his scrotum, a monstrous growth that. . .weighed more than 70 pounds and tied him a prisoner to his barrow,” you probably thought Michener was taking poetic license.  He wasn’t.

The 2.85 billion at risk for malaria are also those most at risk from neglected tropical diseases.   As Alanna Shaikh pointed out in her entry on this blog yesterday, malaria “shares territory, climate, and even modes of transmission with NTDs.”  The clinical outcome of childhood malaria and malaria in pregnant women is dramatically higher when combined with one or more NTD, and there is evidence that even susceptibility to malaria is increased by NTDs.

Furthermore, according to an article published in 2008 in PLoS Neglected Tropical Diseases by Drs. Peter Hotez and David Molyneux, the anemia caused by malaria is increased dramatically when combined with an NTD such as hookworm disease, of which there are almost 200 million cases in Africa alone.  More than anything else, this anemia is what makes malaria and NTDs “diseases of poverty”—adults can’t work when they are very sick, and children can’t learn. 

There is good news out there.  In addition to the positive things mentioned by Ms. Shaikh, UK’s Department of International Development (DFID) states that 11 African countries are “approaching elimination” and Rwanda and Ethopia have seen a 50% decrease in malaria cases.  

The Malaria Vaccine Initiative, a program of PATH, is conducting late-stage clinical trials on a vaccine against malaria.  Also, Sabin Vaccine Institute’s Vaccine Development Program, in partnership with Malaria Vaccine Initiative and Johns Hopkins University’s Bloomberg School of Public Health, is working on the development of a very exciting “transmission-blocking” vaccine (yes, I said “exciting,” “vaccine,” and “development” all in the same sentence).  In other words, if a mosquito “bites” a person who has been inoculated with this vaccine, it may render that mosquito unable to infect any other person with the disease.    So maybe some year in the future on August 20^th we can all roll up our sleeves and stick out our arms and be nice to mosquitoes, if just for one day.

 Nathaniel Wolf is an Information Officer for the Sabin Vaccine Institute. He is a fan of the Washington Nationals and is currently working on his first screenplay.

Women outside clinic in Gashora, Rwanda. Photo: Lindsay Wheeler

It’s hard to argue against the fact that there are many global health interventions that can go a long way toward the control and elimination of  many neglected tropical diseases (NTDs). Global health initiatives have become an intrinsic part of international aid policy.

At a low financial cost, single disease campaigns  in various countries like Rwanda, Burundi, Mali and Sierra Leone for instance, have seen success in deworming children and treating patients for schistosomiasis, onchocerciasis, and trachoma.

However, a recent study conducted in  Mali by the Antwerp Institute of Tropical Medicine and published in the journal PLoS Neglected Tropical Diseases found that single disease campaigns while beneficial, weakened the overall health care system and interfered with routine healthcare delivery and provision systems.

The Antwerp team examined 16 healthcare centers in Mali that were involved in a large-scale integrated treatment campaign funded by USAID and a number of pharmaceutical companies in order to tackle lymphatic filariasis, river blindness, schistosomiasis, soil-transmitted helminthiasis and trachoma.

They found that of the 16 centers, only two were sufficiently staffed and supported and were able to conduct normal duties during the drug distribution campaign. The other 14 centers faced enormous operational problems. People were getting treated for specific NTDs, but healthcare for their other ailments were not being tended to.

According to the authors, “Several informants also criticized the high priority given to targeted diseases, while more common health problems received little attention; they worried about the campaign mobilising energy and diverting staff’s attention from routine care delivery.”

The authors also found that while training and education helped staff improve specific drug delivery, it did address other disease control strategies, such as sanitation and curative care.

Overall, the authors contend that mass drug administration for NTDs is still crucial and a positive global health initiative, however they stress that health system strengthening must be improved.

“Health system strengthening should rely on country-specific development plans aligned with national policy, and requires a comprehensive approach across diseases and health problems and coordination among GHIs…..Progress towards effective and inclusive health systems will not result from the sum of selective GHI interventions.”

The treatment of NTDs in countries that suffer from a high disease burden is a necessity, there is no argument here.  However we cannot overlook how global health initiatives impact and disrupt existing health systems.

Urine samples from school-aged children from Nérékoro in Ségou region of Mali. Three samples on right show visible haematuria, which indicates infection with S haematobium. Three samples on left are not haematuric at visual inspection but could still contain abnormal number of red blood cells. Urine cloudiness (third sample from left) is early sign of abnormality. Photo Credit: The Lancet

In an editorial in the August 13 edition of The Lancet, authors representing the Sabin Vaccine Institute, the World Health Organization (WHO) and the Imperial College of London call for increased supplies of praziquantel for the African continent.  Praziquantel is the only commercially available treatment for human schistosomiasis, a devastating neglected tropical disease (NTD) affects an estimated 200-600 million people worldwide, with the vast majority of cases occurring in Africa, and causes chronic anemia and inflammation associated with severe disability among children, adolescents and young adults. Schistosomiasis produces a disease burden that could exceed that of malaria.

NTDs are devastating, disabling and debilitating parasitic and bacterial infections that adversely affect the poorest 1.4 billion people worldwide living on $1.25 a day. Such conditions promote poverty because of their impact on child growth and development, pregnancy outcome, and worker productivity, all of which adversely impact the earning capacity of already impoverished individuals and communities.

Authors Dr. Peter Hotez (Sabin Vaccine Institute), Dr. Lorenzo Savioli (WHO), Dr. Dirk Engels (WHO) and Dr. Alan Fenwick (Imperial), emphasize that because an estimated one billion tablets are needed to treat 400 million people annually or every other year, at least 10-20 times the currently donated praziquantel is necessary to increase treatment for schistosomiasis in Africa.

The authors conclude by stating that, “… praziquantel is urgently needed for sub-Saharan Africa now, and the current failure of the global community to provide access to this essential medicine is impeding sustainable development in Africa. The shortages of praziquantel should be treated as an African humanitarian crisis.”

 Read the full article here