CABI Blogs: hand picked... and carefully sorted

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

 
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.

Why Latin America is nearer elimination of rabies than Africa

 
"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.

Stepping out in the countryside - how much is it worth?

 

Staff at the CABI HQ in Wallingford this week are making an extra effort to get up from their desks to walk around the building, and the surrounding paths and lanes may be seeing more groups of people than usual out for lunchtime walks. This is all down to a ‘wellness’ campaign in which pedometers have been made available to staff in exchange for a small charity donation, with those obtaining them recording their steps during the working week to meet a group target of one million steps. Also occurring this September is a national fundraising ‘Stepember’ campaign for the disability charity Scope, where participants are challenged to clock up 10,000 steps a day. Here at CABI we are fortunate to be in an area where lunchtime walks can take in fields, woods, and even the banks of the River Thames, making outdoor exercise a much more appealing idea than walking around an urban block. Thus it was timely today to read a story carried on various news outlets about the value of natural environments for health, when the benefits of exercise carried out in parks, woods and other open areas are converted to monetary value. The study by the University of Exeter and Public Health England, published ahead of print on the Preventive Health journal website, estimates that so-called ‘green exercise’ provides health benefits worth £2.2 billion a year to adults in England. 

One hours exercise offsets the effects of sedentary days

A meta-analysis of studies covering over 1 million people finds that doing at least one hour of physical activity per day, such as brisk walking or cycling for pleasure, may eliminate the increased risk of death associated with sitting for 8h a day. The findings come in one of the papers in a special series published in The Lancet on 27 July, ahead of the summer Olympic Games opening in Rio next Friday.
Image: Pixabay.com

To look at the impact of activity and inactivity, researchers led by Professor Ulf Ekelund of the Norwegian School of Sports Sciences, Norway and the University of Cambridge, UK, went back to the authors of 13 existing papers and asked all of them to reanalyse their data. The 13 papers were taken from 16 studies selected after a systematic review of six databases, with the 13 final papers providing data on sitting time and all-cause mortality. Of just over 1 million people in these studies, 84,609 (8.4%) died during the follow-up periods of 2-18 years.

The results found that people who sat for eight hours a day, but were physically active, had a much lower risk of premature death compared with people who sat for fewer hours a day, but were not active. This suggests that physical activity is particularly important, no matter how many hours a day are spent sitting. In fact, the increased risk of death associated with sitting for 8 hours a day was eliminated for people who did a minimum of 1 hour physical activity per day. The greatest risk of death was for people who sat for long periods of time and were inactive.

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

 
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.

Blood donation in post-Ebola West Africa

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 ?

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

  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.

 

Malaria control, disasters and conflict

WHO European Region announced last week that Europe is now malaria free. This is great news to coincide with World Malaria Day this year. The challenge is to make sure Europe remains free of malaria into the future.

Europe has been declared malaria free before, back in 1975. What happened to allow it to return?

Malaria incidence and invasive plants – is there a link?

25 April is World Malaria Day – a time to reflect on the steps we can take to tackle this terrible disease. Much progress has been made in the fight against malaria over the past 15 years, like the use of bed nets impregnated with pesticides, but 3.2 billion people are still at risk. If we are to achieve a 90% reduction in global malaria incidence and mortality by 2030 we must do more.

The path will not be easy. Mosquitoes are becoming increasingly resistant to pesticides – the front line of defence from malaria today. But there are other aspects we can consider, like the potential link between the incidence of malaria and invasive, non-native weeds.

Can the air we breathe be increasing our risk of diabetes?

World Health Day this year focuses on diabetes prevention and treatment with emphasis on what lifestyle changes people can make to stop themselves getting diabetes. There is some intriguing evidence that although lifestyle factors are influential we should also be considering some other environmental factors that could be influencing the risk of disease. One of those factors is air pollution.