The last lepers, and the lack of African surgeons: two articles in The Atlantic

The Atlantic had two good articles out over the winter break that I’m just getting to now; I’m posting them here not because they’re extraordinarily well-written or insightful, but because they’re about topics that deserve greater attention.

The first considers leprosy and the difficulty of eradicating a disease.  In medical anthropology class, I had mentioned that in human history we have successfully eradicated only one disease (of humans) globally: smallpox.  Given our resources in global health in the 21st century, why is it so hard to accomplish the eradication of disease?

Leprosy is a good example of how hard this push can be.  It’s hard to study and the routes of transmission aren’t that well understood (not unlike its close relative, Buruli ulcer).  Worse, it develops very slowly, is easily misdiagnosed, and treatment efficacy is limited.  And social stigma, although its role can easily be exaggerated (something we’ll be thinking about in class), has also played a significant role in rendering the disease and its victims invisible.

The second article concerns a topic that badly needs more discussion: the astounding lack of qualified medical personnel to treat sub-Saharan African populations (the article references a study that finds 9 surgeons per 6,000,000 people in Sierra Leone; I would guess that this is only slightly lower than the West African average).  The results are predictably horrific: inadequate care, malpractice by the undertrained and/or under-equipped, and a system that has little power to retain the qualified.  It’s not a perfect article, but I’m glad that it does two things beyond simply raising the subject: it references Paul Farmer and Jim Kim’s paper on the need for surgeons in the developing world; and it mentions that half of US foreign aid in global health goes to getting ARVs for the HIV+, but a negligible amount goes to training qualified surgeons in poor countries.  Many doctors I work with themselves note this strange disparity between funding and the most pressing medical needs.

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