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Archive for October, 2009

Interview: Gregory Bisson

In Current Issue, Interviews on October 29, 2009 at 11:52 pm

UPenn’s rising star in infectious disease and epidemiology

Gregory Bisson is an Assistant Professor at the University of Pennsylvania in the Department of Medicine’s Infectious Disease Division and a Senior Scholar at the Center for Clinical Epidemiology and Biostatistics. His work focuses primarily on the study of HIV and its co-infections with an emphasis on its presence in Africa. Dr. Bisson aims to bridge the gap between epidemiological research and clinical medicine to improve healthcare for HIV patients in Africa.

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Interview: Julio Frenk

In Current Issue, Interviews on October 29, 2009 at 11:44 pm

A conversation with the new dean of the Harvard School of Public Health

Courtesy Wikimedia Commons

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Curing a Country

In Current Issue, Student Spotlight on October 29, 2009 at 11:31 pm

China’s Challenges in Controlling Tuberculosis

Jenny X. Chen ‘12, Contributing Writer

Courtesy Negi Images

I was let out of school early because I had been coughing, with a low fever of a hundred degrees. My mother said to sleep it off, that it would be okay. There was not much to do but grimace and wonder when the dizziness and breathlessness would end, when everything would around me would stop sounding so muffled, overshadowed by the loud, insolent thudding of an overworked heart. There was not much I could do but try to sleep it off.

Sometime, later that night, my illness went away. And, in a way, so did his. But, while I woke to a school day and a crying mother, lost in a phone call to China, my cousin never woke. And his mother has never really stopped crying.

Separated by some 7000 miles, the United States and China differ in more than just geographical location. Cultures change as we sidestep the time-zones, and the diseases of the world ebb and flow across the geographical and political borders. TB bacillus, a threat to life in China that is incomprehensible to most Americans, currently affects nearly one third of the human population of the world; 1 in 10 of those affected contract active TB. In China, TB is the number one cause of death due to infectious disease in adults.

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Physicians in Pursuit of a Moral Life

In Current Issue, Student Spotlight on October 29, 2009 at 11:20 pm

Morals and Medicine in Modern China

Bianca Verma ‘09, Contributing Writer

Socialist ideology is pervasive in Chinese life, and thus digs deep into the moral core of individuals within the society. Arthur Kleinman defines a moral life is as “one that embodies our own moral commitments” (Kleinman 2). He goes further to note that those “who seek to live a moral life may develop an awareness that their moral environment, in the first sense, is wrong” (Kleinman 3). While businessmen and politicians may already operate in accordance with socialist-capitalist ideals, and thus embody their “moral environment” in that they are profit-driven and competitively seek to achieve their own ends, physicians are posed with a dilemma. While we hold American physicians to an ethical code that stresses the greater good of humanity and puts the patient before self, the temptation for individualistic motivations are thrust upon physicians in reform era China. In Priscilla Song’s article, “Cutting Edge Tactics: Practicing Health Care with Chinese Characteristics,” the nation clearly does not provide adequate financial or institutional support to physicians (only stringent laws and censorship), making it very difficult for physicians to survive without incorporating more selfish actions. However, while these actions may appear to be profiteering and self-interested, in reality, their moral frames have only modified to accommodate for the state’s external pressures, while still ideologically working for the greater good of the nation. In “The Honest Doctor” by Philip Pan, we find that even despite political secrecy and immorality, the unique morality of the physician can indeed shine through. Thus, we cannot necessarily proclaim that physician morality has degraded in reform era China, but rather altered under political and economic pressure.

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Leprosy Now

In Current Issue, Panorama on October 29, 2009 at 11:13 pm

An Ancient, But Still Neglected Disease

Kira Mengistu, Staff Writer

Courtesy Wikimedia Commons

Since its first documentation, leprosy has been one of the most heavily chronicled diseases. Unfortunately, some aspects of the disease and its treatment have remained obscure for thousands of years. It was not until the early years of modern medicine, in 1873, that Dr. Armauer Hansen of Norway made the astonishing discovery that leprosy was caused by a bacterium (Mycobacterium leprae) that this disease became known as a public health issue instead of a curse from God.

Over a hundred years later, technological advances have facilitated a greater understanding of the science behind the disease. Leprosy is a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract and that it causes extensive damage to the skin, limbs, nerves and eyes. Fortunately, research has led to development of effective multidrug therapies (MDTs). The MDT treatment course consists of 2 – 3 powerful drugs that, taken together, can prevent transmission after the first dose and can cure patients within 6 – 12 months.

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The Modern Plague

In Current Issue, Panorama on October 29, 2009 at 10:57 pm

The Cholera Epidemic in Zimbabwe

Lavinia Mitroi, Staff Writer

Courtesy Julien Harneis

Exceeding original worst-case scenario figures proposed by the World Health Organization (WHO), the ongoing cholera epidemic in Zimbabwe has infected over 93,000 individuals and taken the lives of over 4,000, according to a March 27 WHO update.

Since the outbreak began in August 2008, the Zimbabwean population’s needs have been difficult to meet with a heath care system that has been in decline since 2006, evidenced by the nation’s life expectancy at birth of 36 years, the lowest in the world.

Inadequate water treatment and sanitation systems have only provided an impetus for the spread of the infection, which has seen a cumulative death rate of over 5 percent, five times greater than the usual death rate from cholera, according to a report released in January by Physicians for Human Rights (PHR). The situation has only worsened with a spread of the epidemic to all ten of Zimbabwe’s provinces and exponential growth.

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Two Bills for Health

In Current Issue, Panorama on October 29, 2009 at 8:31 pm

Foundational Approaches to Global Health

Rajarshi Banerjee, Staff Writer

459px-Bill_Clinton

Courtesy Wikimedia Commons

Bill Gates made headlines earlier this year when he released a jar of mosquitoes onto an influential and unsuspecting audience during a talk on malaria at the Technology Entertainment Design (TED) Conference in Long Beach, California. After a few moments of nervous laughter from around the auditorium, Gates had to assure everyone the insects were not infected, drawing his loudest round of applause.  Over the last couple of years his foundation, as well as The Clinton Foundation, has invested heavily in the fight against a disease that continues to affect millions annually. While both non-governmental organizations (NGOs) claim they will achieve significant success against malaria by 2015, they have taken very different approaches to eradicating the disease.

Malaria is a leading cause of morbidity and mortality in many countries: there were over 247 million cases in 2006 alone, compared to 3.2 million cases of HIV/AIDS the previous year.  The Gates Foundation carries out malaria control programs in several sub-Saharan countries, and Gates-funded initiatives have led to progress in malaria control in Zambia and Ethiopia. However, the foundation focuses much of its efforts on researching drugs, developing vaccines, and exploring new prevention strategies. This has occasionally led to controversy.

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Interventions

In Current Issue, Panorama on October 29, 2009 at 11:57 am

Targetting drug users in HIV prevention in China

Marianna Tu, Staff Writer

Courtesy of Wikimedia Commons

Courtesy Wikimedia Commons

In 2007, 729 needle exchange programs were established in the People’s Republic of China as part of the effort to combat HIV/AIDS epidemic among intravenous (IV) drug users. These programs contribute to growing optimism surrounding government responses to HIV/AIDS, as demonstrated by UNAIDS public acknowledgment in July of 2007 of China’s Vice Minister of Health, Dr Wang Longde, and Qingdao University professor, Zhang Beichuan, for their HIV/AIDS work (UNAIDS). Countrywide, HIV/AIDS interventions are being scaled up. The 729 needle exchange programs of 2007 represent over an 800% increase from 2004, when only 90 needle-exchange programs existed country-wide (harm reduction journal).

Today, although China’s AIDS epidemic has spread throughout the nation and touched all provinces, advocacy and intervention campaigns continue to heavily target a few sub-populations. These groups notably include IV drug users, sex workers, men who have sex with men, and ethnic minorities. Experts worry that focused interventions, though innovative and localized, threaten to further harm already marginalized populations. In particular, as Chinese health workers, within and without the government, struggle to reach IV drug users in particular, legal and moral controversy abounds.

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The PACT Project

In Delivery on October 11, 2009 at 11:25 am

Health Promotion from Haiti to Boston

Lulu Tsao, Staff Writer

Courtesy of PACT

Courtesy of PACT

As she talks about the recovery of one of her clients, Magalie Lamour-Médé’s voice is filled with warmth and pride. When they first met, Lamour-Médé’s client was “literally at death’s door.” Struggling with HIV/AIDS, she weighed only 84 pounds and had difficulty adhering to her medications. After joining the Prevention and Access to Care and Treatment project (PACT), the patient not only regained weight and suppressed her viral load, but also improved her relationship with her teenage daughter and overcame substance abuse.

As one of PACT’s community health promoters, Lamour-Médé serves some of the most marginalized AIDS patients in the Boston area. A joint project of the Brigham and Women’s Hospital and the nonprofit Partners in Health (PIH), PACT began in 1999 to assist patients who have poor access to and utilization of healthcare. Its community-based model comes from PIH’s work in Haiti, where accompagnateurs provide directly observed therapy (DOT) and social support. Here in Boston, PACT’s major initiatives—harm reduction, health promotion, and DOT—seek to address AIDS from prevention to care.

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