August 4, 2011
by Tavish Nanda
If there is one field of medicine I’m not sure I can stomach, it may be dermatology. There is something about our most visible organ system that makes me a little queasy, which is why I found my fascination with Dr. Ryan’s lecture on African elephantiasis to be a little out of character.
Elephantiasis is generally a parasitic-born condition, but in central/eastern Africa, it is more commonly known as podoconiosis (podo meaning feet) — a condition caused by micro-particles of silica in agrarian locations. For the hundreds of African farmers who farm barefoot in the red clay soil, infection of the skin, especially when it is dry and cracked, can result in the blockage of the lymphatic system in the lower legs. This results in the massive accumulation of lymph, accompanied by fibrosis and inflammation where the cells of the leg actually multiply into the hard “elephant”-like condition seen below (hence the name).
When Dr. Ryan first introduced himself as a dermatologist, I thought to myself, “What could a dermatologist possibly do in tropical medicine?” Not that the field is any less substantial than the rest, but I wasn’t sure how much help someone could be treating skin rashes or burns, when HIV, malaria, and dysentery are ravaging the very same countries. But with elephantiasis, we learned about more than just the condition — we learned about a culture.
We learned how barefoot farming was more than a lack of shoes, but a cultural belief in a natural connection with mother nature and the soil, where the very idea of blocking one’s contact with the ground doesn’t seem as “logical” as it does in western tradition. We learned about the immobility caused by the condition, and the practice of ostracizing those afflicted from their families and communities. Not to mention the inability to support themselves or, in the most unfortunate cases, a family of their own.
Looking at these legs and feet, the most common question is — is it reversible? To my surprise, it surely is. The cure? A bucket of water.
Yes, after years of medical training, Dr. Ryan has reverted back to the use of our most natural life-source as a means of eradicating the condition — away from pills, expensive surgeries, and therapy. This was the most intriguing aspect of the lecture. With weekly bathing of the feet and legs, light massage to move the lymphatic fluid, and short yoga sessions, all patients have seen dramatic reductions in their condition.
This may be nothing short of a miracle yet it’s the most simplistic regiment I could have imagined. And a true perspective on Global Health.
In the west, we never really think about how important it is to wash our skin. We smell nice after showering, but so what? No one ever thinks about how exfoliating water is for our skin, preventing the very cracks and sores that become infected.
In the west, we always fantasize about the next genetic revolution, the next miracle vaccination, a twenty hour energy drink…but we forget the very miracles that surround us on a daily basis. The miracle cure exists, and it comes out of your shower head every day.
If I’ve learned anything so far, it’s that doctors are more than practitioners and teachers. They are deliverers. I wouldn’t want to be egotistical enough to say the deliverers of miracles. But for those whose miracles are clean food and hygiene, they might as well be.
And after studying Global Health here at Oxford and listening about the thousands of lives being saved by simple, hands-on aid — it’s hard to see myself going through ten years of schooling and helping Hollywood stars with their flu infections.
After all, who doesn’t like to travel?
August 3, 2011
by Sara Sameshima
Ever since I went to Honduras two spring breaks ago for USC’s Public Health Brigades, I have thought about the importance of prevention and how at times it is even more crucial than treatment. This concept has been reinforced more than ever by our time here at Oxford. With our global health experience at Oxford entering its final week, I am now even more convinced that prevention is as equally important as treatment in creating an effective healthcare system, especially in developing countries. It may seem like common sense, but if it were common knowledge, then we would not have half as many health problems as we do today. Throughout this course, we have been given insight to our world’s most serious health problems, including tropical/infectious disease, sexually transmitted infections, obesity and non-communicable disease. Our professors are at the top of their fields and are undoubtedly experts in the epidemiology, prevalence, and treatment of the world’s issues. Though they come from a wide variety of backgrounds, it was obvious to me that there was an underlying theme between all: the importance of prevention.
Exhibit A: Vaccines, everyone’s favorite childhood memory at the doctor’s office, save thousands of lives a year because they protect and prevent us from deadly diseases. Dr. Susanne Sheehy, our lecturer on vaccinology, emphasized that vaccines are probably one of the most successful cost-effective interventions to date. Vaccines helped us eradicate smallpox! Exhibit B: Dr. Terence Ryan showed us the simple act of washing one’s feet goes a long way in preventing many of the developing world’s dermatological issues of the feet. Clean skin and proper emollients protect us from cracks/sores and subsequent infections. Exhibit C: Dr. Karina McHardy shocked us with the statistic that 80 percent of all cases of Type 2 diabetes would not exist if there was no if obesity. Obesity is such a worldwide epidemic and so prominent that it is even present in countries concurrently suffering from malnutrition – the “double burden” as experts call it. She stressed that obesity, a medical condition, is particularly tragic because it is such a preventable disease if one maintains a healthy lifestyle. Exhibit D: We may think of this as a no-brainer, but Dr. Lucy Dorrell spoke about Sexually Transmitted Infections and how the simple act of using protection would stop many cases of Chlamydia, Gonorrhea, Trichomoniasis, etc before they even start. The good stuff.
This is just a small nibble of the sweet cookie of knowledge we have been treated to at our time here. (By the way, Oxford’s “Ben’s Cookies” is hands down the best cookie place I’ve been to. On second thought, we just had a talk about obesity…). I could go on and on about how each professor has enlightened us with the types of health issues plaguing our planet, but I think you get the picture. As Dr. Peter Sullivan reminded us, doctors are teachers; after all, doctor in Latin means “teacher.” I know for a fact this statement resonated soundly with all of us. As future medical professionals, it is our duty to ensure that our patients not only receive proper treatment for their ailments but to also make certain they learn ways to prevent it from reoccurring as well as ways to ward off other diseases.
“Give a man a fish and you will feed him for 5 days, but teach a man to fish, and you will feed him for a lifetime” or so the clichéd story goes. Dr. Merlin Wilcox, our lecturer on traditional medicine reinforced this quote when he presented the question: “What is left when you leave?” Treatment only goes so far when your patient does not have access to the treatment you administered on a regular basis. How do you help a community become more self-reliant in the developing world? There is no correct answer, but in my opinion, education is definitely a forerunner. Education about the importance of prevention seems like such a simple concept, even almost “common sense,” but really, it’s surprising how even the most basic methods of disease prevention, such as washing your hands, is still not used universally! My two weeks here has flown by thus far, but if there is anything that my fellow classmates and I need to remember from this course when we go our separate ways into the world, it is that sometimes prevention is better than a cure.
Sara Sameshima a senior majoring in Health Promotion and Disease Prevention as well as East Asian languages and cultures in USC Dornsife. Sara is from Honolulu, Hawaii.
by Keven Stachelek
We arrived on Monday supposedly to learn about nutrition, a subject I have always regarded as either crushingly boring or frustratingly intractable, and were met by Dr. Peter Sullivan, a current Reader (a professor in the U.S.) in the Department of Paediatric Gastroenterology. I prepared myself for a healthy amount of learned theorizing with few practical solutions. And I was not surprised. Truly, practical solutions to global malnutrition are quite primitive: Goiter and Cretinism can be cured by iodizing salt; and Vitamin A deficiency, the most common cause of blindness in Sub-Saharan Africa, can be eliminated for the cost of a yearly ketchup packet-sized supplement. These tragedies are no less affecting for their simplicity, but the real story is the patterns of consumption and waste that undergird our society. Dr. Sullivan’s work is not bound up in micropipettes and petri dishes. He is instead concerned with the everyday decisions all of us on Earth make, that on a global scale add up to appalling nutritional inequality, and he is not shy about naming his enemy. As the lecture progressed, I was surprised to find myself truly inspired.
I returned to my dorm at Oxford’s Lady Margaret Hall brimming with quiet determination. It then occurred to me, that though I had a fair understanding of the structure of modern medicine, and a passable knowledge of international relations, and had been accepted into a competitive course at a prestigious university, I had no definite idea what “Global Health” was. I had proceeded under the indistinct assumption that it was medicine in “other” countries. And over the length of BISC 499 I have encountered similar terms like “Tropical Medicine” and “International Health,” lumping each into the same general category.
Initially I was embarrassed to realize my own ignorance. Had I written numerous application essays, traveled across an ocean, spent not only mine but USC’s fortunes on something I knew not what? I fumbled about, imagining Global Health as international aid, or medicine in adverse circumstances. None really satisfying that inspired feeling I had experienced after Dr. Sullivan’s talk.
After having spent time researching this most obvious of questions, I have made a somewhat startling discovery: no one really knows what Global Health is. Or at least, not many can agree. Now “Tropical Medicine” or “International Health” have each been around for centuries. But Global Health as a discipline has only been in existence for about 20 years. Most of its history waits to be written. Luckily, there are an important few whyo can agree on what it will become. I quote here from a recent publication by Professors at the University of California, San Francisco, University of Cape Town, and Muhimbili University in Tanzania (a truly global endeavor):
“Rather than repeating the colonial approach of the early days of tropical medicine, or the development aid approach of international health, the increased connectedness of the 21st century provides academic institutions around the world the opportunity to work collaboratively to develop research programs to redress health disparities and education programs to nurture global health leaders capable of tackling looming global threats wherever they occur. Arranging practical ways to monitor the extent to which these academic initiatives fulfill their intentions is a crucial next step.”
The impending globalized future that so many seers predict is not just an eventuality. We are only beginning to experience a global civilization. The time to educate doctors in Global Health was last decade. Maybe, if we all start early enough we can catch up in time. If I can make a contribution, I will have my introduction at Oxford to thank.
Keven Stachelek is a junior majoring in biology and philosophy from Fullerton, Calif.