The traditional uniform is causing more problems than you think
The traditional uniform is causing more problems than you think
Gisele Bundchen pees in the shower. Oh, but the absurdity doesn’t end there. She’s telling other people in Brazil that they, too, should relieve themselves while they take a bath. Don’t believe me? Take a look at this video from Brazil promoting, perhaps a cleaner and more environmental meaning to a “golden shower.”
Arguing that more than a quarter of the water you use in your house is for flushing the toilet, they ask the question, “Why not save some water by peeing in the shower?” Get an extra use out of those pipes when you take a leak.
I know what most of you are thinking. First reaction was probably something along the lines of “that’s disgusting, I would never…” But the conscience of your conscience reminds you that you’re probably just as guilty as others – 75% of other. You’re in good company. In an anonymous poll, as many as three-fourths of people indicated that they are guilty of relieving themselves while taking a hot bath (even thought they may not admit it to their friends). Now doesn’t that sound fantastic. Picture you’re taking a hot steamy bath after a long arduous day at work. And while you let the hot water caress your body, all your aching muscles begin relaxing. Then other things start relaxing… and relieving. It’s completely freedom and bliss. Let’s let that sink in.
But I imagine that even (or especially) Gisele would lay out some grounds rules. It’s probably not a good idea to urinate in the shower if the water’s not running. The whole thing that turns people off about urine is the smell. Wash that stuff away, and don’t let the smell linger. And it’s probably not the most respectful thing to pee in a friend’s shower. And as for public or gym showers – I’d say that there is already a growing list of things that irk me off about those places. Urinating is not something I want to add. And just as a PSA, please don’t pee on other people’s private property; don’t end up like this guy:
But this whole topic begs a question: is really safe to pee in the shower? Whenever the topic of developing world public health comes up, inevitably the conversation goes to shit. There are so many things that come out of the rear end of a human being, no wonder there are so many diseases that are essentially transmitted via fecal matter: giardiasis, hepatitis, cholera, and the list goes on and on. But it only recently occurred to me that the conversation rarely, if ever, goes to urine.
I did a quick search to see what diseases could possibly be transmitted by urine. The verdict is that urine is a non-toxic and sterile liquid. The only way a disease can be transmitted from Person A to B is if Person A has some sort of urinary tract infection. But in this case, it wouldn’t be that the urine is the cause of disease – it would be just be the means of transport.
I’d like to bring your attention to a disease called acromegaly (not shown in the above picture). It’s got an interesting name, resonant of some evil villain. And the English translation makes it sound even more so. In Greek, the two root words that gave rise to the name of the disease essentially meaning, extreme and large. Beware of the acromegaly attack!
It’s a hormonal disease that develops with the pituitary gland produces too much growth hormone in adulthood. Your hands, feet, and face and characteristically the first features to enlarge. The disease can lead to other seriously illnesses, and can even be life-threatening if not treated in due time.
This disease is supposed to be uncommon. But a couple years ago, I was interacting with a camp of political protesters outside of the National Assembly of Nicaragua. If rare means 1 in every 20 or so, then I guess it is rare.
These farmers were protesting against the government for some form of reparation. Dole Food Company had employed these farmers, and the use of persistent organic pollutants (POPs). The sorts of diseases I saw there made it look like a live chapter out of medical textbook. The men were sterile, every other person had huge tumors growing from some area of their body, and many of them had children born with deformities. And some had acromegaly. One grandmother showed me a picture of what she looked like before. Now, the part of the skull between her eyes had widened to twice its original size. Her sockets separated, and her eyes protruded outwards. Without sounding too insensitive, her condition looked someone like the eyes of a butterfly moor.
These protesters kept mentioning something called Nemagon. I didn’t know what it was at the time, other than its role as some sort of pesticide. When I returned to the States, I did some research and found that the active ingredient in Nemagon is 1,2-dibromo-3-chlorpropane (DBCP). This nematicide was banned in the United States in 1977 by the EPA, but it continues to linger in the ground water and soil from areas where the use of DBCP had previously been widespread. And American companies are still producing and using this stuff in developing countries. I don’t know where to start on the ethics of this.
In the Nicaragua event, the farmers were given $600 million in reparations by the Dole Company – as though this money were going to somehow reverse the effects of the use of DBCP. An interesting thing to note, is that one of the producers of DBCP is Dow Chemical. And although they warned Dole Food Company about the adverse health effects of this chemical, Dole threatened to sue Dow if stopped shipments.
Let me now draw your attention to the Stockholm Convention that was set forth by the UN Environment Programme aiming to restrict the use of POPs around the world. It is signed by all nations except just a few, including the United States. Let’s just allow that thought to sit for a moment.
When I hear the terms tropical medicine or international health, I think of, well, the tropics. I think humidity, rain, monkeys, and mosquitoes. Wherever the weather is tropical things grow, including diseases. But what happens on the other side of the spectrum – towards the poles? I’m not even sure if the Arctic falls under the jurisdiction of what is conventionally thought of as international health, but I’m going to go for it anyways.
How can the Inuit (meaning simply ‘People’ in Inuktitut) contribute to the theme of global health? Global health often deals with marginalized societies around the world, mostly from developing countries. While the Inuit and other ‘First Nation’ people are mostly from the northern regions of Canada, they often face poverty and marginalization. In a sense, they share very similar social characteristics as those living on Reservations in the United States.
While I have never been to the far north of Canada, from the little information I’ve gathered on these people, the most striking feature of their attitudes towards health is the strong sense of community. Here in the United States, and in other developed nations, allopathic medicine is king. Even in Far Eastern countries, allopathic medicine has extended its influence beyond Chinese medicine to be used in all settings that is considered to be ‘serious’ in 99.99 percent of the population. People and their illnesses are treated individually, and so the combined effort of a community is seldom seen. There’s a reason why groups of random individuals don’t convene anymore to decide what to do with you, the sick one. The practice of medicine is typically restrained to the relationship among the doctors, nurses, patients, and their drugs. Doctors and nurses are specialists and have the knowledge to health.
What the Inuit have done may seem counter to our ultra-specialized society. Cures and treatments are not to be kept just by the doctors, but rather are common knowledge. The community involves themselves altogether in their folk medicine to treat conditions from boils to mental illnesses. The relationship with the community is a key ingredient in the process of healing. There are a few exceptions to this, however. Surgeons, shamans, and midwives do carry with them specialized training and knowledge, and some still think that the youngest child of the family has the capabilities of healing everyone else. Just get the last child to lick your infection – it’ll go away. (No, but in all seriousness, don’t).
And like other traditional medicine found around the world, the Inuit too have managed to take what their land provides them with, and try to find use in them to treat disease. The Inuit didn’t undergo scientific studies for their medicine. Much like the early days of ‘Western medicine,’ everything was tested with trial and error. If it was perceived to help the sick, then it was used as medicine.
To treat boils, you would first place a wet lemming skin on the skin to draw up the infection. When the boil is ready to be cut into, it will feel cold to the tip of the tongue. The piercing is done with a bone fragment, and the tendons from a caribou are used to pull the pus out of the boil. Different Inuit communities will dispute where the lemming skin should be placed. Some say on the leg, some say belly, but overall the procedure seems similar.
Sore joints are treated with a topical application of green algae from river rocks or by warning the area with rocks heated over a fire. You can control your bleeding by first washing the area with urine then applying the spores from certain mushrooms to the cut. Bearberry tea can be used to help with stomachaches. Seal fat is often used as an ointment.
The Inuit’s recognition of mental diseases seems progressive compared to Western medicine. It took us a long time to figure out that there could be something done with our “crazies” and “lunatics” instead of sending them to prison. The Inuit have strict guiding principles when dealing with community members with mental health problems. These rules promote the stability of the town as well as the person by avoiding hurtful gossip and by bringing the community and families together. But when there are mental difficulties, relationships are strengthened, and bonds are made tighter.
The reality is that the customs of the Inuit are slowly being drowned out by Western culture. Western medicine is slowly erasing the long history of Inuit medicine, and part of this is because of the general poverty of the Inuit. Canada’s healthcare doesn’t provide traditional medicine for these people. But it still remains that for a great number of ailments inflicting the Inuit, especially the ones dealing with the cold, people still hold onto their traditional methods. While I’m not sure if I’d urinate on an infection, I would still believe an Inuit man over anyone else if I were facing snow-blindness or frostbite. I’ll side with the hundreds of years of trial and error on this one.
The sky was a clear, the air was chill and thin – pretty typical weather being so high up in the Andes. It must have been in our third week working, staffing clinics in indigenous communities high up in the mountains where llamas would perch on peaks like pigeons would here in Los Angeles. The ride was always long getting to these remote locations, and there were many instances when I thought the van would slip off the narrow mountain paths. The constant swerving around the mountain didn’t help us – motion sickness was something that each of us just had to deal with. Matters were made worse, of course, by the more than 15,000 ft worth of altitude sickness.
But each time we arrived at our chosen destination, our spirits lightened up as we typically were welcomed with a swarm of smiling children all wearing their characteristic red ponchos. But on this particular day, there was something else to lighten our spirits. An elderly lady comes out with a tray of plastic cups with a light green tea. Not green tea, but coca tea.
I was a little taken aback at the offer, to be quite honest. She smiled as she gave us the tea, with a face of assurance than any grandmother would give. She told us it would make us feel better after the long ride and a long day of work. The messages we receive stateside about anything remotely cocaine-related makes the thing sound like the sin of all sins. The “Devil’s leaf,” as it was known by early Spanish clergy in Central and South America a few centuries back, still has that foreboding allure. But what the hell, I was in a different country with different laws and attitudes. And what can I say? It hit the spot. It was nice and hot, and warmed the body to the bones. And it was just the right amount of sweet. Not sugary sweet, but a subtle and enticing sweet. Later I found that the amount of tea I had can accrue as much as 4 - 5 mg of cocaine.
This leaf comes from the coca shrub family Erythroxylum spp. There are more than 30 species within this family, but most of the commercial exchange of coca involve two: E. coca and E. novogranatense. I won’t go into detail about how this plant has made its way into Western culture. Instead, what is the history behind coca? How is this plant being still being used by indigenous communities not only for medicinal purposes, but as a source of cultural identity?
First, lets go through the science-y part of coca before getting into anything else. The active ingredients of interest in coca are called alkaloids; the main ones are cocaine and cinnamoylcocaine. The plant contains other alkaloids as well, and anecdotally, different concentrations of these, in combination with different compositions of other essential oils produce different flavors and aromas. Some people claim that much like fine wine, there are subtle but important differences in taste. And in spite of the fact that cocaine can lead to malnutrition as it suppresses appetite, chewing the leaf can satisfy daily nutritional requirements for calcium, phosphorous, riboflavin, and vitamin A. But don’t start taking this stuff as your daily multivitamin.
The coca plant is pervasive in South and Central America. It obviously is involved with the drug trade that is plaguing many Latin American countries, but also has its veins deeply rooted in the history and culture of the region. The plant was used for its medicinal properties, most identifiable among these is its stimulating effects. But this plant was also gold. Much in the way coffee has been described as black gold, coca was their black gold. Much more than black gold, in fact.
Thousand year old mummified remains have been found all throughout Latin America along side bags of coca leaves. A lot of these mummies were found with periodontitis – tooth loss from long term chewing. This leaf, which is and has been so entrenched in society, was used as a suitable offering to the gods. Some civilizations would offer the best and freshest leaves of the coca to the gods before allowing themselves to enjoy it. And the plant was a sign of privilege. It was for the rich and elite, and was meant to be just for men, although women did a bit here and there, too.
Coca was a staple in the Incan economy, and the spread of the empire was partially financed through coca plantations. The Incan royalty would give away bags of coca as awards for accomplishments, priests would throw the leaf into rivers in hopes that the gods would ban illness and would smoke the leaf in hopes of achieving divine inspiration. Sure, divine inspiration. Have you upset the mother of the earth pachamama or her daugter cocamama? Bring a bag of coca with you. Have a reason to appease the wamanis – the mountain gods? Same procedure, unless of course you’re a woman. In that case, you may run the risk of being “swallowed by the mountain.” Not sure how that works.
White llamas, the representative beast for the royal Incan families, were trained to chew on coca leaves. The Inca would exhume bodies and make offerings of coca leaves to honor the dead. And when the Europeans arrived in modern-day Peru to conquer the Inca in 1532, tributes of coca were paid to Francisco Pizarro and to other conquistadores. The Spanish increased production of coca and made it available to peasants so that they would work harder and longer in silver and gold mines. Coca flowed through the veins of the Inca, and then in the veins of the Spanish colonists, and it made them powerful.
Soon wines and beverages would be made with coca, and were immensely popular in the Western world. Coca-cola was first a kola nut extract with coca. Pope Leo XIII endorsed Vin Coca Mariani, a wine with coca, with a Vatican medal of achievement as it made him feel less fatigued. Through the efforts of drug wars, policies, and public health advocates, the rage of coca was snuffed, but it still remains a vital component of the modern day descendants of the Inca. One of these tribes are the Quechua. These are the people I interacted with during my days in the Andes.
As I have already mentioned, chewing the leaf is a sign of cultural identity, and hence is governed by a complex list of etiquette rules, including one that states if you refuse offered coca tea, it could be taken as a sign of your asocial nature. It’s a cultural identifier for these people, much like the ponchos and the braided hair. Coca has also been used as a measurement of time and distance. One cocada gives you either 45 min of walking or 2 km on steep terrain.
Typically, when the leaves are chewed, the dried leaves are placed between the cheek and gum and moistened with saliva. A bit of lime is usually put in the center. The alkali in the lime helps separate the alkaloids (the active ingredients I mentioned earlier, including cocaine) and promotes faster and stronger release, much like tea in hot water. Chewing is not the only way to appreciate coca. There’s tea, as I’ve already mentioned, but there’s also snorting and smoking, which are more commonly seen among priests and medicine men. The carved out gourd used to hold the limes, ishku, is called a ishkupuru. And the wistalla is a small bag used to hold the leaves. And now I feel like the DEA will be after me for blogging about this.
Still today, coca serves its divination purposes. Instead of asking an 8-ball for help, you might consider approaching a chrajchrakuj – one who knows how to chew. There’s a belief that kuka willan (coca tells). One example of this practice is by observing sides of the coca leaf as it is released by the chrajchrakuj’s hands. If the dark upper side of the leaf faces you, then you have a kara, a good omen. Conversely, if the underside of the leaf faces you, you have a chapa, a bad omen.
You may be asking yourself how prevalent this practice still is? While I can’t say how wide spread approaching a chrajchrakuj is today, but it is estimated that upwards of 80% of rural communities in the Andes still rely on coca in order to meet their health needs. So yes, coca and cocaine are still integral components of tropical medicine, especially if your interests lay in the South. And yes, after that cup of coca tea, I did start to feel much better.
Picture source: Flickr © narcotraficantex
It has been described as having a characteristically horrific smell. So bad in fact that dermatologists many times are able to smell it before even seeing it. The tumors sometime grow like purple cauliflowers on the limbs of its victims. It’s a skin cancer that is rarely seen in the United States, but is the most common skin cancer found in Africa. It accounts for almost 10% of all the cancers that come out of that continent. It’s Kaposi’s sarcoma.
In 1872, the Hungarian dermatologist Moritz Kaposi was working at the University of Vienna. He described, what later became known as Kaposi’s Sarcoma (KS), as an idiopathic multiple pigmented sarcoma of the skin. In other words, there was this skin cancer of which the cause was then unknown, but always manifested looking like a blood vessel tumor. Kaposi thought of the cancer as uncommon, the majority of cases appearing in Eastern and Southern European patients. Little did he know that this disease was endemic in Africa, even before a sharp increase in AIDS.
The tumor grows slowly, but quicker among AIDS patients. It often manifests as a characteristic red-to-blue, or purple, nodule with brown tints that many times becomes dome-shaped. Earlier lesions often appear on the extremities - for instance, toes or soles - and have been described as being bluish-black with a dusty finish. The disease migrates from the extremities inwards, rarely extending to the face. Once in a while, the disease will go into remission, especially in the earlier phases, but it leaves behind a dark scar.
There are four categories of KS: classic, endemic, epidemic, and iatrogenic. The classic form of the disease is what Kaposi would have seen in Austria. The disease is seen in middle-aged men of Southern or Eastern European origin; Jewish and Italian men have been of particular note, especially in New York City. This type of the disease is rarely seen among women.
The endemic form of the disease is primarily seen in tropical regions, especially in Africa. This form of the disease is further subcategorized into two forms: endemic African cutaneous KS, and endemic African lymphadenopathic KS. The cutaneous form of the disease is very aggressive, affecting middle-aged men in Africa. The other form of the disease is chiefly seen in children under the age of 10. Even before the onset of the HIV-AIDS epidemic in Africa, these forms of KS were quite common. The AIDS-related form of the disease significantly aggravates morbidity and mortality.
Epidemic AIDS-related KS is seen commonly in patients who have AIDS, and not just in Africa. The prevalence of AIDS-related KS has been well documented among American homosexual men. This form of the disease is often attributed to the interaction between the Human Herpes Virus 8 (HHV-8). Interestingly, this has become the most common form of AIDS-related malignancies in Sub-Saharan Africa. Death from this form of KS is expected typically within a year or two.
The final form of the disease is called iatrogenic, or transplant-related KS, and is related to immunosuppression. In other words, this disease affects those who have a suppressed immune system, for instance those with other cancers who are undergoing chemotherapy, or those who have recently received an organ transplant who are under immunosuppressive drugs.
If I were you ask you what you thought the most dangerous animal to humans was, I would venture to guess that many of you would say something along the lines of spiders, sharks, wolves, or perhaps vampires – if you’re so inclined. But do you honestly believe that spiders, sharks, wolves, or Edward Cullen could be responsible for the illnesses of 700 million people every year and millions of deaths? Is Stephanie Meyer really responsible for that many heart aches? I mean head aches.
In Spanish they’re known as little flies. And indeed, mosquitoes are small flies from the Culicidae family. And much like vampires, mosquitoes feed on animal blood, but there are still many more species that do not consume blood, such as the mosquitoes from the Toxorhynchites genus. Both male and female mosquitoes mostly feed on the nectars of various fruits and plants, but only the female mosquitoes are responsible for blood sucking, especially during her time of egg laying. The proteins, fats, and sugars in blood are perfect for this.
The connection between mosquito bites and diseases was not made until recently. In fact, the majority of the time, mosquitoes will feed on their prey in such a way that does not transmit disease. While working at the Panama Canal, a few US Army physicians hypothesized that the mosquito was the route of transmission of malaria and yellow fever. Indeed, this discovery by Walter Reed and William Gorgas would save millions of lives later on.
Mosquitoes are everywhere, except for Antarctica, but that goes without saying because the truth is, there exists very few things that far down. They’re especially active in warm and humid regions of the world, which is unfortunate as many developing nations without the infrastructure and resources to deal with mosquito-borne diseases are in tropical regions. The proliferation and spread of mosquitoes, and the diseases they carry, has become especially difficult to deal with in recent decades as human activity takes non-endogenous species to foreign regions. Sea transport is often the culprit of this phenomena: the trade of flowers, tires, and cars, for instance, also act as carriers of mosquitoes.
I’m sure that there has been someone in your life who has confused vampires with mosquitoes by telling you that eating garlic will help repel mosquitoes. As it now stands, research done at the University of Connecticut has shown that garlic will neither attract nor repel mosquitoes. On the other hand, common experience has shown that garlic will repel other human beings with statistical significance. According to another study, drinking lots of beer will make you a mosquito magnet, however.
Female mosquitoes, instead, detect their prey by detecting organic substances produced by the host, such as carbon dioxide. This may be why your larger friend over there gets more bites than you (larger people expel more carbon dioxide) or why people get bit more while exercising.
With over 3,500 species of mosquitoes, the behaviors and habits of mosquitoes vary drastically. Most mosquitoes feed at sunrise or sunset, but some, like the Asian tiger mosquito, will feed only in the day. Some mosquitoes prefer urban areas, others prefer rural. Just to give you a flavor of a few types of mosquitoes, take a look at this. The Aedes aegypti mosquito transmits many viral diseases, such as yellow fever and Dengue fever. The Anopheles mosquito carries the parasite Plasmodium, which causes malaria. The Culex and Culiseta mosquitoes are known to carry diseases such as tularemia and West Nile Virus. Fortunately, vector transmission of HIV has been shown to be extremely unlikely. Just this reason is precisely why controlling mosquito population and disease transmission is no easy task.
But if there are millions dying from mosquito-born diseases, what can be done about the situation? There are some practices that can engineer a reduction in mosquitos and consequently disease. There are four main categories: source reduction, biocontrol, trapping, or exclusion. Source reduction could be something like filling tires with dirt to prevent the accumulation of water (I should mention that mosquitoes breed in stagnant water). Trapping is essentially killing the mosquitoes, and exclusion would include things like screened windows and bed nets. An example of biocontrol, which I find to be quite interesting, is implemented by introducing dragonflies in the environment. The nymphs of dragonflies will eat mosquitoes at all stages of development, are harmless to people, and are generally nice to look at. But their introduction brings in other concerns about the balance of the ecosystem.
Picture source: © Ben Heine
The Speaker of Uganda’s Parliament, Rebecca Kadaga, who is pushing forth the Anti-Homosexuality Bill
It will come as no surprise when I say that policy is crucial in health. In the 19th century, when the city of London came together and decided that free flowing sewage in the streets contributed to the spread of diseases as cholera, a change in attitudes and policy led to a dramatic reduction in communicable diseases. Today, Obamacare acts as a huge policy overhaul in this country. Many of the results of this change are yet to be seen, but there’s no doubt that things are going to look very different in the world of American healthcare in the next presidential term.
But the theme of this entry is to talk about something on the other side of the Atlantic in Uganda. The notorious Anti-Homosexuality Bill that made its debut in 2009 has reemerged and is now in the works of becoming law by the end of this year. The bill has roots in antiquated British colonial law. But the bill was initiated by a member of Parliament named David Bahati, and has been supported by a number of groups who claim to be Christian (many of which are in the US). The Parliament is calling this a “Christmas gift” to the Ugandan people. To free the African nation of the sinful agenda of the gays is what is needed in order to protect the children from the homosexual threat.
Let’s break down the law into its major components. Homosexual acts are categorized as being either “Aggravated” or “an Offence.” An aggravated act of homosexuality is defined as being any same-sex act committed by an individual who has HIV, is an authority figure, administers intoxicating substances, or commits sexual acts with minors or disabled members of society. An offense of homosexuality includes any same-sex sexual act, or an attempt to do something more “aggravated.” The punishment for the former is the death penalty. The latter is life in prison. In an act to exercise its own sovereignty and independence, the country is refusing to acquiesce to the strong opposition from Western nations to stop this bill, even if that means losing precious aid. The Speaker of the Parliament, Rebecca Kadaga, claims that the bill is not meant to promote homophobic violence. But this isn’t really evidenced by Uganda’s recent history.
It’s not hard to believe that this sort of law will be deleterious to the LGBT community of Uganda, and perhaps in neighboring African nations. Violence towards gays and lesbians has been permissible, but now will be enforced and promoted by law. There is no doubt that this law poses physical threats. But there is another threat that remains hidden deeper in the human psyche.
This will only make sense to you if you feel that homosexuality is something that you’re born with rather than something you learn. In a recent podcast on the NY Times Science Times, John Schwartz, a national correspondent for the NYT and the author of “Oddly Normal,” talks about something generally called minority stress. This is a phenomena that is too real in this country, and certainly has its place in Uganda as well. Unlike being a racial minority, where one is able to confide in parents, ethnic communities, and churches in episodes of discrimination, sexual minorities find themselves “being alone in concealment” having no source to fall back on. This difficulty is aggravated further by the fact that internal stress begins to build up as disparaging message against the LGBT community are internalized and believed. Research shows that all these factors are psychologically damaging; but I don’t need research to convince me.
Any responsible member of society who is truly concerned for the health and quality of life of this sexual minority will vehemently oppose this law. Although it seems as though there’s nothing to stop its momentum now. I’m afraid that this law is a virus disguised as moral integrity in a God-fearing nation. Parliament claims that they’re protecting Ugandan children from the homosexual agenda; they fail to realize that their bill is going to make poor Ugandan children feel that their lives were mistakes. There is a growing disease in East Africa, and it must be stopped. The cure: common sense and compassion.
(Source: The New York Times)
A child with Leishmaniasis. (Picture source: NowPublic © Swan)
You might think of her as being no different than any other 12-year-old. Her alternating bands of black and purplish hair makes you think that she wants to express herself in unique ways as she stands on the brink of puberty. But this girl from the Northern Acre Region of Brazil had no chemicals touch her hair. Her alternating colors were instead an indication of an internal issue: nutrition deficiency.
When you hear the word dermatology, what are the first words that come to mind? Acne? Sunscreen? Skin cancer? Botox? The profession comes with a love-hate relationship. Dermatologists have a reputation of having the easy life: low-risk procedures, office hours, a robust paycheck, and endless samples of SPF 85+ Neutrogena samples. While doctors in the U.S. grudgingly respect dermatology (as it remains one of the most competitive fields of medicine to get into), somehow they’ve forgotten that this field carries a very different face to most people in the world.
Dermatological conditions in the developing world still revolve around infectious diseases, complications with parasitics, and perhaps contact with a venomous creature or plant. Fortunately, many of these conditions are treatable with various antisera or antibiotics. But much like other tropical diseases, access to treatment remains at a chronic low.
For a few years, I would tell myself and others that I was interested in this thing called ‘Tropical Dermatology.’ The response I most encountered was, “Wow, that sounds interesting, but what is that?” The truth was, I didn’t really know. Tropical medicine and dermatology both interested me — if ‘tropical medicine’ hasn’t already existed, I would’ve invented it.
Fortunately, through word of mouth, I met a real tropical dermatologist at Harbor-UCLA: Dr. Noah Craft. When I described to him what interested me, his response was ‘uncanny.’ Our histories and passions had sounded so alike, it was almost as though I was looking into my own future. Dr. Craft has dedicated a large portion of his academic career studying a skin diseases called Leishmaniasis, a parasitic diseases transmitted by female sandflies with a large majority of its incidences occurring in Brazil and the Indian subcontinent.
But what importance does tropical dermatology have for us as we continue into the twenty first century? Like with the girl from Acre, dermatology is being used in creative ways in poorer regions of the world to diagnose serious, yet unseeable, conditions. It’s almost as if something that goes wrong inside will manifest outwardly. Therefore, doesn’t it sound likely that dermatology can be used in a greater capacity that allows us to better understand disease and diagnose conditions in a more expedited manner? There is a grand world of dermatology outside of Botox®, but it seems as though few chose to venture into these lands as many of the perks of skin care must be checked at the door.
They are known as favelas (Brazil), kijiji (Kenya), johpadpatti (India), gecekondu (Turkey), aashiwa’i (Egypt), barriadas (Peru), kampungs (Malaysia), and mudukku (Sri Lanka). (Picture source: Flickr © Ogodi)
They called it Basura because all you could see was the garbage of the city of Managua piled in hills next to a small lake sprinkled with floating fish and rainbow pools of oil. My health probably would have fared better if I didn’t breath at all — you see, the hills were on fire. Hard to believe, but there was a village and even an elementary school inside this place. The police weren’t incorrect when they felt it shouldn’t have be in our interest to enter the slum. After all, this place and so many more like it remain ignored by outsiders.
As my first post, it seems only appropriate that I talk generally about slum communities. My visits to the slums of Nicaragua were what initially inspired me to look deeper into this subject. While there’s little known about the particular slum I went to, others are shown to teem with a myriad of health issues. Particularly in slum communities with burning garbage and urban run-off, there are higher concentrations of these things called POPs (persistent organic pollutants) — a POP that you may have already heard of is DDT. The member nations of the Stockholm Convention on POPs recognize the need to reduce the prevalence of POPs as they are linked to a great number of health complications. I’ll just throw one out there: The Emperor of All Maladies, Cancer. Annoyingly, but not surprisingly, the United States has yet to join.
When I came back to the Bay Area, I came across a professor named Lee Riley who made it his mission to better understand and serve slum communities, especially those in Brazil. Walking into his office was much like walking into an airport souvenir shop in some Latin American country. There was a can of Brazilian ground coffee on his shelf, chocolates from Peru, and a whole array of charts and tribal masks lining his walls. As I write this, I remember that I’ve also been this house. It’s more or less the same except with less scattered papers on desks and more scattered books on couches.
One of his most cited papers is titled “Slum health: diseases of neglected populations.” His observations made on slum community in the city of Salvador, Brazil, illustrates the urgency of addressing such marginalized communities. More alarming yet, there are more than a billion people who live in slum communities around the world, and this number is on the rise. These communities are breeding grounds for all sorts of public health concerns, but also provide a target point for potential preventative health care successes. What happens is, illnesses go largely undetected and unnoticed in these communities until things reach a point of no return. According to this paper, diseases are typically ignored by the formal health sector until greater complications or death. Thus it is imperative to adopt a new strategy when addressing this great disparity. But before health care institutions go about poorly allocating resources, there needs to be a greater understanding of the true environment of wellbeing and diseases within these communities. Riley et al. calls for a new approach to assessing slum health. It is in our best interest to first understand the complex “social-cluster determinants of diseases” to better allocate resources to these populations before it’s too late. Who’s in?
An interesting point this papers makes, that adds to the urgency of this issue, is that while governments spend billions of dollars preparing to bird flu pandemics (this paper was written in 2007), epidemics of diseases that are being incubated in growing slum populations may “reverse all the economic gains made in the last 2 decades” in emerging economics as Brazil, Mexico, and China. Hard to imagine? HIV/AIDS did something similar to Africa in the last two decades.
There are many honorable and well-intentioned efforts to reduce poverty and empower these communities, but do we really understand how to tackle this beast?
If you’re interested in this subject, check out the work done by Lee Riley at Berkeley’s School of Public Health or Albert Ko at Yale’s School of Public Health.