July 26, 2012
By Sheena Khanna
When people are asked why they like traveling, they often reply, “to gain perspective.” This can sometimes seem like a vague, cop-out answer that saves them from having to explain any more. But it’s not. In reality, there is a lot of meaning to that statement. Whether it’s appreciating something as simple as having a hot shower or something more profound like not having to worry about where the next meal is coming from, traveling truly teaches us important lessons in terms of what to be grateful for on an individual level.
But traveling can help us gain perspective on a higher level, too. Most of us on this study abroad course at Oxford have a pre-medicine emphasis in our studies at USC, and many have the end goal of becoming doctors. For me at least, when I’m at USC shadowing doctors, I picture myself in their situations one day—showing up to work, taking care of patients, completing administrative duties, and also juggling my family life at home. It’s very easy for me to focus on what my own lifestyle will be like, and I forget about the other 7 billion people in this world.
But traveling—studying abroad here in the UK—really reminds me of how much else is out there. There are other ways to live my life, other types of people to serve, other whole countries in need. It seems almost selfish, then, to simply be worrying about myself, when my eyes are opened daily to more groups of people who are suffering, more aspects of a certain disease that have yet to be tackled, and more partnerships that are being forged in order to solve problems that require global cooperation.
On one hand, it’s easy to feel hopeless and say, “forget it, there are too many problems in the world, I’m not going to be the one to solve them, let me just go and live my own life and be happy.” And then you dismiss all of those people in need and just get a job somewhere and only worry about whoever appears in the clinic that day. But a lot of aspiring physicians these days (at least within the people I’ve encountered at USC) seem to mention that they’d like to travel abroad and serve as international physicians. That, to me, is promising.
I realize that not a lot of people are going to devote their entire careers to global medicine by moving to a third-world country in Africa. That sort of individual, who is willing to devote his entire life to his cause, is rare but amazing. Ultimately, the rest of us want to have our experience in that arena but then move back to the comforts of home and enjoy life. (Please don’t be offended if that doesn’t apply to you, I realize it’s a generalization. But I feel like deep down inside, that blanket statement actually covers a lot of us, whether we choose to admit it at this point or not.) However, our efforts-to-be are admirable too, if we can make them count. It struck me today that the ways to do this are not all as profound as we may think they have to be.
Today, Dr. Peter Sullivan of the Oxford University Department of Pediatrics gave us a lecture on nutrition in children in less developed countries. It centered on iron deficiency, vitamin A deficiency, and iodine deficiency. What struck me the most was how relatively simple these ailments are to cure. Pills of iron, large annual injections of vitamin A for children, and iodized salt are some of the solutions that were mentioned, and all were much more affordable than, say the drug cocktails needed to treat HIV. For some ailments, the exact cause is not yet known or there is no good treatment that has been developed yet. But for these three problems, we know exactly what the causes are and how to treat them. What’s more, the world definitely has the resources to combat these problems. If that’s the case, if we have the ability to solve these problems, then the real question is: why don’t we?
Some say that these problems are “small” in comparison to HIV, malaria, and tuberculosis. They don’t garner enough prestige to be worried about as those bigger issues do. Others say that people just don’t know, don’t think about these issues, and that’s why they don’t get addressed. So if we are part of the lucky few who do know about this problem that is out there and has great potential to be solved, then wouldn’t it be a great accomplishment if we all came together and solved it? That’s where I say we, as future doctors, can step in.
Global health is about more than just the delivery of healthcare. It’s about the organization of it, too. We need to find the people who care about nutrition, people who are willing to jump on the bandwagon—even if it’s just for a little while in the broad scope of their careers—and work as a team in an ongoing effort. Imagine: if each of us dreams of volunteering abroad as a physician for three weeks, and we coordinate it so that we all go to a certain village in succession, with just twenty of us we can provided continued care for over a year. That’s all it takes: twenty people with the same goal, but in a coordinated effort.
We could each do our time in that small village in Africa, administering vitamin A injections or distributing iron pills and salts. We could make our suggestions on how to fortify their foods. Even if we each did something small, it would all add up, and we could leave there having significantly improved the nutrition situation, just by persistence. In my opinion, that seems better than each of us running our own individual efforts against malnutrition. With everyone aspiring to contribute but no one willing to devote his or her entire life, it seems like a viable solution. And, it’s quite feasible. Once the nutritional deficiencies have been addressed, the stage will be set to address more severe problems. Taking action in small pieces shouldn’t be underrated, because if you look back after a while you’ll see that the progress you’ve made is a lot bigger than the tiny steps you took to do it. That’s the perspective I’ve gained.
Sheena Khanna is a junior majoring in Neuroscience from Oak Brook, Illinois.
By Ryan Lau
Across the Ugandan marshlands, the sun sets along the western border, casting brilliant fires of red and orange across the sky. In the quiet marsh, the reeds whistle and hum as a cool breeze rushes through, preparing animals of all sizes to come out and begin their night. Along an empty riverbank a soft slap echoes across the marsh as a rubber sandal hits the moist mud comprising the bank. With a week-old baby wrapped in a sling and a basket upon her head, a lone woman travels back from the medical clinic, a vast distance of 60 kilometers (37 miles) from her home village, in order to receive her Human immunodeficiency virus (HIV) medication. It is a long night ahead.
This story revealed by Dr. Sarah Walker of the Development of Anti-Retroviral Therapy in Africa (DART) trial is not uncommon to the people of Sub-Saharan Africa; in fact, millions all across the nation require medication for HIV but are unavailable to retrieve it. HIV is an epidemic that has spread across the globe and has become extremely severe in Sub-Saharan Africa.
How fortunate are we as citizens of the United States and members of the Trojan Family of USC to be able to walk down to the nearest pharmacy and pick up some Tylenol or even have the ability to drive far distances to receive a medical consultation. Too often we take for granted how blessed we are to be living in the US. Never have I heard of anyone in the US walking for a full day in rubber sandals and overcoming countless obstacles just to receive medication. It is absolutely unheard of.
As seen through the DART testing, without medication patients have an 8% chance of survival. With medication and strict CD4 testing, the survival rate shoots up to 90%; with just medication and clinically driven testing meaning that the toxicity test was given only if needed, the survival rate remains relatively similar at 87%. What is the bottom line? They need medication, regardless of testing.
We live in a place where we have the means to achieve what it is we need—whether it is covered shoes for walking or a means of transportation. Not only that but we are a land where technology must be at the very tips of our fingers at all times. However, if we take a step back and look at what we spend our money on, we find that it would take less than 200 USD a year to provide one person with the Anti-Retroviral Therapy they need. To put in context, they need this 200 USD to live. In 2012, how much does the cheapest iPad, a source of entertainment, go for? 399 USD.
What I call upon is a change in perspective. Domestically, we have programmed ourselves to have the best of everything, the newest toy, and the best quality service. We strive to continually become better and be the best, and this is what has helped surge us through to the top. Though we must continue to do this to improve, we must not be negligent of our fellow human beings not so fortunate to be in the same position as us. We must use what opportunities and resources we have to bring them up and aid them in their epidemic. We in the United States do not have as nearly as severe a problem as that of Africa.
This presents many dilemmas, as this problem is one that requires global context, but this in itself creates multiple problems in the politics, economics, and business, as each country has its own system, its own rules, and its own barriers. However, if we look at the very basics, we are all human beings, so why is it that we cannot help fellow citizens of the world? It is easy to say that someone else will take care of the situation, but it only takes one to start the change. It only takes one to create a revolution. It is up to each of us – to the lawyers, the businessmen, the doctors, the government officials and every profession in between to start the change. It only takes one.
Ryan Lau is a junior majoring in Biology from LaCanada, California.
By Michael Bell
“Don’t pee up river, pee down river.” Wise words coming from my fellow classmate as we were coming out of lecture on diarrheal diseases.
Diarrhea is always in the back of the mind of the experienced traveler. And we know that all too well. Already, we’ve had our fair share of comic relief from sharing stories of our Imodium use to our bowl movements timing so that no one misses out on the fun of being abroad. Ingesting a strange bacteria and getting diarrhea can be a “real bummer” for travelers from developed countries as our lecturer Dr. Osama Khalid likes to say. But for the poorer corners of the globe, this is a serious disease.
Diarrheal diseases is the second leading cause of death in low-income countries and fifth in middle-income countries but virtually nonexistent as a leading killer in high-income countries. Because diarrhea results from the contamination of food or water, a strong correlation between sanitation and diarrheal death exists. The catch with this disease is that it’s preventable with clean water, adequate nutrition, and maybe even a little soap—all things that people should have access to regardless of class or creed. Another scary thing about this is the viscous cycle of disease, death, and chaos. In developing region, especially the rural slums of Asia and Africa, the political instability leads to the lack of proper infrastructure to ensure a source of clean water. The lack of clean water results in infections of the enteric system causing diarrheal diseases, which in turn incapacity the population to build infrastructure and even leads to more unrest.
Possibly, the saddest part of this disease is its affliction on the child population especially those under the age of five. Because children have weaker immune systems, higher water content, and are particularly vulnerable to malnutrition, diarrhea affects child more often and much worse than adults. It causes 1.8 million child deaths in Asia, Africa, and Latin America. Mother has a solution this however—breast-feeding. Full of clean nutrients and immunological booster, breast milk effectively reduces the chances for her child to develop the disease. Problems occur when a mother has too many children. She can’t breast-feed them all, and so usually only the youngest will get this scarce product. Diarrhea kills children very slowly, weakening them with each case depleting them of nutrients and dehydrating them. Eventually, the children become too fatigue and their immune system too weakened that they succumbed to what would otherwise be a dangerous disease.
Luckily, treatment exists for the diarrheal diseases. If the patient is fortunate enough to have access to medical attention, the routine procedure of oral rehydration therapy (ORS) using a solution approved by the World Health Organization (WHO) and zinc supplementation is quite successful. Access is the biggest issue in treatment of diarrheal diseases. My mom always made sure that we knew how lucky we were to be in America; she used to tell us how they would use coconut water in the Philippines instead of ORS.
Really the best thing we can do for developing nations is to ensure a source of clean water and access to it for all the inhabitants. That and those downstream latrines so no one is tempted to pee upstream anyway!
Michael Bell is a sophomore majoring in Neuroscience from the central beaches of Florida!