I can’t believe a new year has come upon us so quickly. Unsurprisingly, there are already global health issues cropping up. In perhaps the most troubling news, India has reported that there are at least 12 cases of totally drug resistant tuberculosis in the country. President Obama signed a ban on US government funding for domestic and international needle exchange programs. A new mobile health program in Kenya offers a smart phone-friendly mobile website and app that act as a medical directory and reference.
Totally Drug Resistant Tuberculosis in India: As Wired reported yesterday, a totally drug resistant strain of tuberculosis (TDR-TB) has been found in twelve patients in one hospital in India. This means that the infection does not respond to any of the currently available antibiotic treatment options, a step above extremely drug resistant TB (XDR-TB) and multi-drug resistant TB (MDR-TB). Although it is not time to panic and buy out the local pharmacy’s surgical mask supply, this is exceedingly worrying, especially on top of the 15 TDR-TB cases in Iran that were (quietly) reported on in 2009 by Velayati et al. That study also underlines the ease with which such TDR strains could be transmitted across borders and that in all likelihood, they already have been. Maryn McKenna of Wired and Malathy Iyer of The Times of India both point out that weak health systems are at the root of drug resistant strains of TB. Inadequate or non-existent diagnostic tools and systems, under-trained and over-burdened health care workers, and lack of adherence to drug regimens or ability to track patients with TB has worsened the epidemic and exacerbated the rise of drug resistant strains. The largest global health issues will not go away unless these service gaps and system weaknesses are addressed. TDR tuberculosis is just a major example of what can go wrong when health care systems are not strong and widespread.
Ban on US Funding for Needle Exchange: As part of the rancorous 2012 federal budget negotiations that ended just before (another) government shutdown in mid-December of last year, President Obama has signed into law a ban on funding for needle exchange programs within the US and abroad, as reported by The San Francisco Examiner last week. Additionally, USAID and other health and development funding was also flatlined, essentially, into 2012, as per the excellent breakdown from the Kaiser Family Foundation. The White House claims it is against the ban, blaming Congress for its reinstatement. It was the Obama administration that lifted a 21-year ban in December 2009, but the winds have shifted drastically since those heady days. Needle exchange programs are a key component of HIV prevention programs and target injecting drug users (IDUs), one of the demographics most disproportionately affected by HIV/AIDS. The San Francisco Gate quotes Laura Thomas, SF Director of the Drug Policy Alliance, who is understandably frustrated with the ban. She said: “Reinstating the ban is murderous. It’s saying that people who use drugs should contract fatal and expensive diseases and die.” Although her words may be intemperate, they do underline that when it comes to public health funding in the United States and elsewhere, the most marginalized and stigmatized populations are almost always the first to be cut out. Needle exchange programs decrease HIV transmission rates and are a necessary component of any successful HIV prevention and treatment strategy. It is a shame that political posturing has once again gotten in the way of rolling back the HIV/AIDS pandemic.
M-Health in Kenya: MedAfrica has released a mobile website and app (usable with a smart phone or feature phone) that offer possible a symptom checker, healthy eating tips, first aid guidelines, and a directory for doctors and hospitals in Kenya. CEO Steve Mutinda and business development officer Mbugua Niijhia discuss their innovation in a video (with poor sound quality, my apologies) for MobileBeat. Technology Review has more, including the ambitious plans for an Africa-wide rollout, new services, and a sustainability strategy. Mobile health, or m-health, is exploding at the moment, as uptake of mobile phones even in the remotest parts of the developing world has seen exponential growth. M-health offers a way for health information to be spread easily and to better inform patients of what and who is available to them, as well as of healthy behaviors. Although MedAfrica’s efforts should be lauded, a review of their mobile site showed a few bugs and some usability issues–which should, with hope, be remedied as the platform moves out of beta. According to Technology Review, there are 25 million phone users out of 40 million Kenyans, and there have been 25,000 downloads of the app since its launch in November. It remains to be seen, however, how widespread such a platform can become when it requires a more expensive smart or feature phone to use. The greatest hope for mobile health innovation is that it will increase access to health care and information, especially for those hard-to-reach patients. As m-health platforms grow in popularity, their designers must ensure that services will benefit as many as possible and not just those who can afford smart phones.
The header photo is the author’s own.
