Soap.

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I love using the toilet in the office of a health NGO that’s looking for funding and they don’t even have any soap. It’s a good proxy indicator. Especially if they’re looking for health and hygiene funding.

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A friend of mine, who works in health in this part of the world. I agree with this sentiment fairly closely. Soap is one of the easiest, simplest, cheapest, and most effective health interventions. The use of soap dramatically reduces the transmission of a great deal of communicable disease, including those that are traditionally thought of as aerosolised. It requires a change in behaviour that is not difficult and nor is it hard to understand. However, it must be sustained and enculturated. Currently a lot of work is being done to promote sanitation in the Indonesian archipelago; on the one hand by organisations such as AusAID, who have instituted programs using community-led self-shaming to motivate long-term change, and also by large consumer product businesses. Soap is a commodity that is cheap to produce and required eternally. To the extent that you can differentiate it in the market and charge a premium for branded or ‘special’ (anti-bacterial, liquid) soaps, it can also be highly profitable. These bode well in the medium term. It will take a while to get it right though, and in the meantime we’ll continue to see plenty of households, businesses, and even health NGOs lacking the basics of sanitation.

Tobacco control in Timor-Leste: weak

The current state of tobacco control in Timor Leste. (“Available now, a new cigarette. The flavour you love.” Pantai Kelapa, Dili.)

MP Josefa Alvares Soares said, as Timor-Leste is a new country with a small population, when the government does not pay attention to this problem it can be a big threat to human resources because now Timor-Leste has a high instance of tuberculosis and cancer also.

… World Health Organization Representative in Timor-Leste Dr Jorge Mario Luna said he was surprised and sad when he saw the advertisement for a new cigarette called 23 in a public place.

“I am sad because Timor-Leste has signed the international convention on controlling tobacco but continues putting the advertisement of cigarettes in public places,” said Dr Luna.

From the Dili Weekly.

Though Timor-Leste does not have the population to rank among the top consuming nations, it has (along with its neighbour Indonesia) among the highest consumption in the world as a proportion of population. The Government is currently ambivalent about tobacco control, as the full extent of tobacco-related-harm has not been realised, and future harms have been insufficiently communicated. Soares comments are informed and articulate ones; tobacco smokers are up to 20 times more likely to develop active tuberculosis – a fact which is not well known.

As it is in the rest of the developing world, tsunami of devastation is creeping up on this small island.

Smoke

There’s a lot of smoke here. More than anyone healthy should breathe. Roadside rubbish-fires. Grilled chicken. Months of hill clearance – land which isn’t used for any subsequent purpose. Cigarettes from local and international manufacturers, exhaled by the nation’s men. Modified motorcycles with Honda exhaust pipes replaced by noisy and ineffective pieces of tin, spewing clouds of blue smoke. All held together by an atmosphere composed of dust and humidity.

It doesn’t add to health, that much is clear. How much it detracts, I’m not sure.

Go down the street to the national humerus fracture program

“I’m sorry, we’re the national TB program, go down the street to the national humerus fracture program.” – Paul Farmer.

As well as being a rather humourous quote (sorry), it also drives home a message that Farmer has been making for a very long time, and one he restates in this speech to HSPH. Diseases cannot be viewed or treated in isolation.

I work in a disease silo, where we have specific outputs that focus on a single malady and its symptoms. There is no doubt that we are having success – we know this because the number of malaria cases here is in steady decline. This in itself is a very good thing, and the spillover effects will be felt elsewhere. Other programs in our organisation address other specific and urgent health needs. Similarly, the health systems that needed to be built are steadily being put together, if somewhat slowly and at the cost of increased ill-health in unaddressed areas; NCDs are approaching us with speed. Nevertheless, the points made make me wonder how we could do things differently, and whether addressing things that communities ask for would give us a better set of outcomes.

Donor visit

Donor visits are always exciting; especially when they’re by people from countries you know well. It’s good to meet your Facebook friends! Unfortunately, they put some strain on time and resources – self-imposed pressure to present a fine image is often intense, as is the need to manage relationships with other stakeholders who themselves have self-representation issues. But, it should go well, there are a lot of good things we want to show them.

Update

Currently working on a agriculture focused integrated vector management (IVM) project proposal for malaria and NTDs here in Timor-Leste. We’re lucky to have very talented staff who can make this a reality… more to come.

Why I do this.

Because eradication is possible. I believe that. Within my lifetime there will be no more malaria.

Malaria: A 25% Solution.

 I visited three new sites and one longstanding project. All faced enormous gaps in medicines, diagnostics and malaria control activities. In some areas the last bed net distribution was 3 years ago, and no indoor residual spraying had been done in over a year. Although a few areas were overstocked with rapid diagnostic tests, many had none; most had no artemisinin combination therapy (ACTs, the first line treatment) or pediatric ACT formulations. Oral and parenteral quinine was generally available, but not parenteral artemisinins, and there were few transfusion materials to treat people with severe malaria-related anemia. These disparities sometimes existed within the same administrative zone.

This article certainly feels accurate based on experience in Indonesia & Timor-Leste. Here, funding covers little more than 1/4 of standard interventions. As a result, transmission continues only minorly abated, with all that entails. Instead of moving towards control, we’re simply dealing with temporary reductions in a continued epidemic.

Is malaria a preventable disease? Yes. We can stop the great majority of cases and deaths. Eradicable? I’d like to find out. But with the weak and impartial application of even the existing tools answering this question is entirely impossible.

http://blogs.plos.org/speakingofmedicine/2012/04/25/responding-to-malaria-a-view-from-the-ground/

New chapter.

So, I’ve been accepted to a position in Timor-Leste, as a malaria control education officer. This is quite a step for me, and the exposition of a lot of collected knowledge. I’ll certainly be keeping you updated, and blogging more regularly.

Partners in Health release new “how to” guide

Partners in Health (PIH) have over the years proven themselves on the forefront of medical aid, working with communities to improve health, and expanding greatly the set of healthcare needs which are considered ‘acceptable’ and deserving targets of assistance. For this reason, I’m excited that PIH have released a new guide, summing their experiences over the last several decades, with a particular focus on building the systems needed to provide healthcare in challenging and low resource environments.

Partners In Health Program Management Guide.

I haven’t read it yet, but I’ll be sure to post further once I’ve got through it.