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Table of Contents

“The Williams Initiative for Global Health, better known as WIGH, was founded with a mission in mind: to provide undergraduate students at Williams College with information regarding global health, as well as opportunities to take action regarding such issues. Since its founding in the fall of 2013, WIGH has made a conscious effort to create a global health awareness on campus by informing Williams students on critical global health issues by using meetings as a place for discussion, hosting dinners, events, panels, and conferences, including, but not limited to, Williams College. Furthermore, we have collaborated with additional organizations on campus to best provide students with opportunities to engage in different global health initiatives abroad. Ultimately, WIGH’s ultimate goals are to provide life-long mentorship, guidance, and knowledge to best create future global health leaders. And so, with these goals in mind, WIGH decided to launch what you now hold in your hands - its first global health magazine. Written by students, for students, we found it was not only important to deliver information to students, but that the information come from our fellow peers, classmates, friends, role models – our most trusted sources – our fellow Ephs. With that said, I hope you all enjoy our inaugural magazine, and the strong works and efforts of our passionate members and students. “ All the best, Katherine Arellano WIGH President

IN THIS ISSUE… 3-4… Doctor Profile Alexander Beschloss ‘16 5-6… Chagas’ Disease Adrienne Strait ‘15 7-8… Diabetes in MENA Annie Rojas ‘15 9-10… Yellow Fever in S. America Emily O’Brien ‘17 11… Return of Poliomyelitis Katherine Arellano ‘16 12-13… Instigating Health Awareness of Globesity Logan Lawson ‘16 14… Cancer Care in Zambia Tendai Chisowa ‘16

SPECIAL THANKS TO: Robert Yang ’15 for cover design Jane Cary: Director of Science and Technology Advising Dr. Polifka: this issue’s profiled doctor Professor Kim Gutschow of Anthropology dept. Professor Lois Banta of Biology dept.

15-16… Access to Antiretroviral Therapy in Developing Countries in the Fight Against HIV/AIDS Kimberly Kiplagat ‘16 17… Sweden’s Healthcare System Heather Biehl ‘14

Williams College Print Services For questions, comments, suggestions, submissions, please email: mc11@williams.edu 2

editor: Minwei Cao ’17


Doctor Profile By: Alexander Beschloss (’16)

DR. Michael Polifka: A Man’s Career, Passion, and Life beyond North Adams, MA

Unfortunately, Dr. Polifka was

DR. MICHAEL POLIFKA began his professional career by studying to become an engineer. He graduated in engineering, but as early as his freshman year, during Aerospace 101, while studying the cross section of an airplane wing, realized that engineering was not for him. He decided instead that he wanted to bring his engineering to the field of medicine by pursuing a career as a hospital management engineer, which led him to teach at the University of Michigan. It was a great, wellpaying job. He hated it. While in Ann Arbor, he realized that he was not the one making a difference in patients’ lives in the hospital. It was the doctors. In order to make that difference, he enrolled in the medical school at the University of Vermont. Once he graduated from medical school, he and a friend of his started a clinic in Manchester, Vermont. This community had only been served by several doctors all of whom were all 85 years or older. This new influx of younger doctors was vital for the community. Eventually, these elderly doctors retired as Polifka and his colleague overtook responsibility for the community. As their practice grew, they found patients with medical needs that their internal medicine specialty did not cover. Polifka began to learn about these specialties by perusing books and journals, as well as speaking to fellow colleagues. Eventually, he was able to recruit more doctors to join the practice, including specialists in family practice, orthopedics, and other areas as well. Polifka's effort to make his practice so multifaceted was a result of his natural proclivity to “do the right thing.” To serve the community, he would make home visits and join patients in the ambulance to the hospital, as he continued to learn about the range of medical specialties from his colleagues.

slowly disheartened to watch public efforts to improve healthcare be incredibly frustrating. Congress rebuffed Bill and Hilary Clinton’s attempt to reform healthcare and Vermont Governor, Howard Dean, was similarly thwarted. Polifka recalled hearing a physician say, “Stop waiting for someone else to figure out the problem. Figure it out yourself and find out how you can help." In taking those words to heart, Dr. Polifka made the first steps. His first idea was to open a school-based health program at the local high school, which he planned to be free for the students. His program was designed to both treat and teach students concurrently.

Dr. Michael Polifka aiding victims of the Haiti earthquake in 2010

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While working in the clinic and educating students in high school, to meet large college bills for both of his children, he took a moonlighting position in North Adams in emergency medicine. He found practicing in the ER increasingly interesting and thus reduced his hours in the clinic. Dr. Polifka was set to retire from the clinic in January of 2005, but the world had other plans for him. Dr. Polifka’s very first volunteer position was with Project Hope in Indonesia. From that point on, he decided that he would go wherever he could to help the victims of disasters, rotating between 1-month shifts in North Adams and his volunteer work. In his personal journal, Dr. Polifka wrote of a particularly moving moment while on Ni’as Island, Indonesia, shortly after the Nias earthquake. He wrote, “A mother had broken ribs as she lay over her young child to protect him (he had no injury), another has a fractured pelvis so bad that the team of surgeons here think that it is beyond them, a man with diabetes runs from his house, cuts his foot and now has gangrene in his diabetic toe,

“…another man weeps in his bed so concerned about the welfare of his family, who now has now home and no way to support his family…”

another man weeps in his bed so concerned about the welfare of his family, who now has now home and no way to support his family when I must tell him that the fracture in his back that has made him a paraplegic is inoperable, and his prognosis for any real recovery is poor…” There was nothing but bad news, however, that did not prevent Dr. Polifka from giving up. He fixed the injuries of those who could be healed, fed them and their families, and sent them back into their “broken world.” Though Polifka is able to make significant impacts on individual’s lives, it seems as if his actions act as a band-aid. Family, poverty, disease, dehydration, and disaster infiltrate and penetrate this protective covering until the band-aid vanishes. Dr. Polifka’s voluntary work first focused on direct patient care. He would load up 100kg of medicine on a donkey, go into the mountains of Nicaragua and move from village to village, treating anyone that he possibly could. This idea might seem unsustainable, but the fact that he was able to save individuals’ lives made it worthwhile for him. Dr. Polifka finds that making a difference to one patient at a time—no matter the extent of his ability to help—is the most gratifying for him.

Dr. Polifka, however, no longer practices this direct patient care as he find that it is not the most efficient and sustainable manner of treatment. He now focuses on mentoring indigenous health providers and practitioners who have a better knowledge of health in their respective countries. Now, when he leaves, the band-aid that he leaves is much larger. For instance, in Liberia, many doctors left because of the threat posed by blood diamonds. To combat this, Polifka supports local forces and doctors to teach them more about medical care and hence, helped to staunch an exodus of medical talent from the country. This change of approach has helped him to conclude that when he departs, the bandaid that he leaves behind will be much larger and more durable. In the case of Dr. Polifka, we see the significance of the practice of medicine in the macrocosm of global health. Global Health programs, as the name might suggest, aims to save and improve the lives of the seven billion or so humans on this planet. But this inevitably leads to a focus on those who live in poverty and away from medical services. Understanding the story of Dr. Polifka, a significant contributor to the wellbeing of thousands of human beings, brings an inspiring sense of how one person of great character and ingenuity can creatively help to deal with this unending struggle. This highlights the significance of the actual doctors, nurses, and other health practitioners in the world of global health. Politicians reserve so much of the focus of global health for policy decisions, however, the actual deployment of the medicine and treatment provided by doctors and other health practitioners does not seem to be in the spotlight. Doctor Polifka’s example shows that having doctors who are emotionally invested in the cause can in fact fine-tune the approach of caring for those who are underprivileged. •♥• More information on Project Hope can be found here: http://projecthopeinthefield.blogspot.com/2010/08/hope -volunteers-go-to-work-in-st-louis.html

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Banda Aceh, Sumatra, after a 2004 Tsunami

Special thanks to Dr. Polifka for taking time to share his story with us.


Chagas’ Disease

By: Adrienne Strait (’15)

The rise of the kissing bug, Brazil’s neglected parasite CHAGAS’ DISEASE afflicts 45,000 people a year. Brazil is the Latin American country that has been hit hardest by the disease: approximately half of the 12 million infected individuals are from Brazil.ii What makes Chagas’ disease so fascinating is that despite its high incidence, little effort has been made by Latin American governments to combat the spread and transmission of this disease. Chagas’ disease is considered by the United States to be one of the neglected parasitic infections (NPI) and is currently being targeted by the Centers for Disease Control (CDC) for public health action.iii

A 2007 epidemiological study conducted by the Public Library of Science (PLOS) indicated that mortality rates have declined in Brazil over the last two decades, yet the disease still poses a significant threat to the health of the country. For example, acute Chagas disease was responsible for 2.8% of deaths between 1999 and 2007iv. There are also distinct regional differences in the prominence of Chagas’ disease in Brazil as shown in Figure 1(right). The rural areas in the Central-West of Brazil have been hit the hardestv. In the Amazon regions of the North, 11% of all deaths are related to Chagas’ Diseasevi.

Fig 1. regional differences in mortality rates in Brazilix

Chagas’ disease presents itself in flu-like symptoms and then can become chronic if not caught early. About a quarter of its victims eventually develop enlarged hearts or intestines, which can fail or burst, causing sudden death. In particular, this disease has led to high rates of heart disease in Latin America. Figure 2 (left) illustrates that mortality rates increase with duration of infection. Recently this disease has been receiving more attention in the United States due to recent U.S. deaths caused by blood transfusions from South America. 5

Fig 2. survival curves in chronic Chagas’ Disease


The parasite that causes the disease is called Trypanosoma cruzi and was discovered by Carlos Chagas in 1909.vii The disease vector is the reduviid bug, commonly known as the “kissing bug,” which is only found in the Americas (refer to Figure 3 [next page] for a visual of this insect). These insects pick up the parasite by sucking blood from infected animals or humans and transmit the parasite when their feces come into contact with the bite wound. This parasite is blood-borne and can live in the human bloodstream for many years without eliciting symptoms in its host.

Dr. Chang-Diaz, from the New York Times, states, “Pharmaceutical companies aren't interested because the disease hits people who couldn't pay for a drug [even] if there was one.''viii Unfortunately, there is currently no satisfactory drug to treat the disease. The Brazilian government needs to give pharmaceutical companies large financial incentives to ignite motivation for drug research. Such action is yet to be seen. •♥•

Fig 3. the adult “kissing bug”

a child with Chagas’Disease

This disease can be transmitted vertically from mother to fetus. There is also concern for transmission in needle sharing and blood transfusion. In Latin America, many blood banks now use a chemical called gentian violet to kill the parasite in donated blood before it is transfused. There are a few different avenues the Brazilian government could pursue in order to reduce incidence. Currently, individuals are only required to officially report acute forms of the disease to the Brazilian government. This is an issue because the disease manifests itself as a chronic illness in most people. An important step in limiting transmission in Brazil is for the Brazilian Ministry of Health to make notification of chronic forms of Chagas compulsory. Additionally, the Brazilian government can focus more of its attention and resources towards the disease. A central roadblock to reducing mortality rates is that Chagas’ disease is an affliction of the poor and, therefore, receives little attention from the Brazilian government.

i Eng, Dinah, “From Jungle to Space in Pursuit of New Drugs,” The New York Times, Novermber 28, 2000. ii Altman, Lawrence. “The Doctor’s World: Scientists Fear That a Parasite Will Spread in Transfusion,” The New York Times. May 23, 1989. iii cdc iv Martins-Melo et. al., “Epidemiology of Mortality Related to Chagas’ Disease in Brazil, 1999-2007,” PLOS. v Martins-Melo et. al., “Epidemiology of Mortality Related to Chagas’ Disease in Brazil, 1999-2007,” PLOS. vi Martins-Melo et. al., “Epidemiology of Mortality Related to Chagas’ Disease in Brazil, 1999-2007,” PLOS. vii Altman, Lawrence. “The Doctor’s World: Scientists Fear That a Parasite Will Spread in Transfusion” The New York Times. May 23, 1989. viii Eng, Dinah, “From Jungle to Space in Pursuit of New Drugs,” The New York Times, Novermber 28, 2000. ix Martins-Melo et. al., “Epidemiology of Mortality Related to Chagas’ Disease in Brazil, 1999-2007,” PLOS.

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Diabetes in Middle East and North Africa -mena threatened by an “epidemic” By: Annie Rojas (’15)

THE RAPID AND DANGEROUS

increase in the prevalence of obesity has quickly led the United States (U.S.) to be categorized as one of the unhealthiest developed nations in the world. These changes in health status, however, have not been unique to the U.S. Countries of the Middle East and North Africa (MENA) have been hit especially hard by the obesity epidemic and, consequently, have seen a staggering increase in the number of new cases of type 2 diabetes in recent years (Figure 1 [left]). Diabetes is a metabolic disease in which the body is unable to produce sufficient amounts of insulin, a hormone that causes cells in the liver, skeletal muscles, and fat tissue to absorb glucose Figure 1. Map of the Middle from the blood. Poor nutrition, a decrease in East and North Africa region.1 physical activity, and increases in obesity and smoking, are all direct factors causing this spike in diabetes. All these causes stem from intense social and economic changes that have occurred in the MENA region over the past few decades.ii The diabetes prevalenceiii rate of 11% in this region is more than double the global average of 5.2%.2,iv Six of the world’s top ten countries with the highest prevalence rates of diabetes are located in the Middle East and North Africa: Kuwait, Lebanon, Qatar, Saudi Arabia, Bahrain and the United Arab Emirates (Figure 2 [below]). Furthermore, the impact of diabetes on mortality is devastating: nearly 10% of all adult deaths in the region are due to type 2 diabetes, surpassing 250,000 deaths in 2011.2 The surge in diabetes prevalence puts stress not only on healthcare providers in the Middle East and North Africa, but also on the economic systems, governments, and individual families as they struggle to cope with the associated rising financial burden. “[Diabetes] leads to low productivity, loss of household income and a rise in health care costs. Now we have clear evidence that such catastrophic expenses can drive families below the poverty line,” said Dr. Ala Alwan, the assistant director general for noncommunicable diseases and mental health at the World Health Organization.4 The MENA region accounts for 9.3% of the world’s adult population with diabetes and annually spends $5.5 billion on the disease, roughly 14% of its total health care expenditure.v These high numbers are expected only to worsen over the coming years. The International Diabetes Foundation expects a 100% increase in the number of cases of diabetes in the region by 2030.4

Figure 2. Prevalence* (%) estimates of diabetes (20-79 years) for MENA region (data from 2011)2

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Left: The MENA Diabetes Leadership Forum of 2011 featured Bill Clinton as a keynote speaker.

While these statistics make for a bleak outlook on the future of diabetes in the region, healthcare professionals and politicians alike share hope that taking extensive, immediate steps could effectively curb the incidence and mortality rates associated with the disease. Among the potential factors that could help to decrease occurrence of the disease is education. A survey completed in 10 countries in the MENA region in November, 2011, by Novo Nordisk, a global health care company, points out that despite 83% of respondents acknowledging a drastic increase in the prevalence of diabetes, only 43% of those at risk of developing the disease considered diabetes to be a serious condition, while 37% had never been screened or had a blood sugar test.4 Dr. Amir-Kamran Nikousokhan Tayar, chair of the International Diabetes Foundation’s Middle East and North Africa region, said that it is now imperative to “encourage governments in our countries to take a 'Health in All Policies' approach and encourage people, in particular parents, to educate themselves on the risks associated with diabetes and to know the signs.” vi With the Middle East on the brink of intense rapid development in energy and technology, creating healthier populations through prevention and recognition of diabetes is crucial now more than ever. Former President Bill Clinton was invited to be a keynote speaker at the MENA Diabetes Leadership Forum in October, 2011, in Dubai.3 “This whole region is in the midst of a burst of modernization, with so many exciting things going on,” Mr. Clinton said, “but it can all be interrupted if we don’t block this diabetes epidemic.”•♥•

Above: North African Jonas Lukano, 60, who has diabetes, is watched over by his sister at the state general hospital. i. Map of MENA region, Green Prophet: Sustainable News for the Middle East, http://www.greenprophet.com/2009/12/mena-solar-power/. ii. “Middle East and North Africa (MENA),” International Diabetes Foundation Diabetes Atlas,” 2012, http://www.idf.org/diabetesatlas/5e/middle-east-and-north-africa. iii. iv. D.R. Whiting, L. Guariguata, C. Weil, J. Shaw, “IDF diabetes atlas: global estimated of the prevalence of diabetes for 2011 and 2030,” November 12, 2011, http://www.sciencedirect.com/science/article/pii/S0168822711005912. v. Sara Hamdan, “Rapid Increase of Diabetes Strains Middle East’s Health Agencies,” New York Times, January 12, 2011, http://www.nytimes.com/2011/01/13/world/middleeast/13iht-M13CDIABET.html?_r=0. vi. Andy Sambidge, “Diabetes cases in Middle East seen doubling by 2030,” ArabianBusiness.com, November 14, 2011, http://www.arabianbusiness.com/diabetes-cases-in-middle-east-seen-doubling-by8 2030-429942.html


Yellow Fever

in South America

A deadly disease caused by the Aedes aegypti mosquito

By: Emily O’Brien (’17)

YELLOW FEVER is an acute viral hemorrhagic disease transmitted by infected mosquitoes. The “yellow” refers to the jaundice that affects some patients. Up to 50% of severely affected persons will die from yellow fever if they do not receive treatment.1 There are an estimated 200,000 cases of yellow fever, causing 70,000 deaths worldwide each year. The virus is endemic in tropical areas of Africa and Latin America. The number of yellow fever cases has increased over the past two decades due to declining population immunity to infection, deforestation, urbanization, population movement and climate change. There is no specific treatment for yellow fever, because treatment is symptomatic and aimed at reducing the symptoms for the comfort of the patient. Vaccination is the most important preventive measure against yellow fever. The vaccine is safe, affordable, and highly effective within 30 days. The vaccine is sufficient to confer sustained immunity and life-long protection. Booster shots are not necessary. There are a multitude of signs and symptoms related to yellow fever. Once contracted, the infection has one or two phases. The first phase usually causes fever, muscle pain, shivers, loss of appetite, and nausea. Most patients improve, and their symptoms disappear after three to four days. However, 15% of patients enter a second, more toxic phase within 24 hours of the initial remission. During this second, more toxic phase, the high fever returns and several body systems are affected. The patient will rapidly develop jaundice and abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes, or stomach. Kidney functions begin to deteriorate as well. Half of the individuals who enter the toxic phase die within ten to fourteen days, while the rest recover without significant organ damage. Despite these specific symptoms, yellow fever can be difficult to diagnose because of the similarities that exist between said symptoms and those of other diseases like malaria. Transmission through mosquitos is the most common. Mosquitoes usually take the virus and transfer it to monkeys. The monkeys then transfer yellow fever to people, and, consequently, yellow fever moves from person to person. South America has prevalent cases of yellow fever. Within South America, however, specific countries are worse-off than others in terms of the number of cases of yellow fever. These countries include Bolivia, Brazil, Colombia, Ecuador, and Peru. South America currently has a rapidly developing economy. 1 As a group, the economies of South American countries have changed profoundly since the 1970s. 1 At the most fundamental level, these countries are exporters of relatively low-value primary products and semi-processed materials. South America is an importer of higher-value manufactured goods. The biggest individual economies in South America are those of Brazil, Argentina, Colombia, and Chile. In addition, there are several countries currently undergoing massive economic growth. These countries include Argentina, Venezuela, and Peru. Major industries in South America are agricultural, which encompasses a vital part of the economy, as well as other important industries that include fishing, natural resources, and handcrafts. Trade also constitutes an important piece of the South American economy.

Politically, the countries of South America are diverse. However, in general, South America underwent a variety of political changes in 2013. For example, in Venezuela, the left wing president Hugo Chávez died in March of 2013. Vice President Nicolás Maduro succeeded him, although the election result was closer than expected and the opposition alleged irregularities. In Brazil, widespread demonstrations took place in major cities This depicts the most common means of in June in protest of perceived economic and social inequalities in the transmission for yellow fever. country. In response, President Dilma Rouseff pledged political and economic reforms, although unrest diminished her popularity.1 9


South American politics in today’s world, as a whole, enjoy certain democratic politics, but a continuous struggle against decades of dictatorships is still present. Fifteen percent of women hold positions of executive power throughout South America. Approximately 13-14% of women in South America hold legislative positions. The current population of South America is approximately 387.5 million people. A variety of factors make it difficult for South American politicians to administer the necessary aid to yellow fever victims. The World Health Organization, as well as a variety of its partners, has thus stepped in to help distinguish cases of yellow fever in South America and provide an adequate plan of dealing with the disease in one of the regions most prone to contracting it in the world.1 Argentina and Brazil have routine yellow fever vaccinations in areas considered at risk. Coverage in these countries among children of one year of age (which is an optimal time to get the vaccination because it lasts a lifetime) is approximately 70%, reflecting the limited availability of the vaccine. Mass vaccination activities vary among countries, including reactive campaigns for outbreak control and preventive campaigns conducted in stages that target the resident populations in enzootic areas, border areas, and areas where migration occurs. For example, Peru vaccinated over 77 million people between 2004-2007. Brazil vaccinated 115 million people in the past ten years, and the Plurinational State of Bolivia conducted a national vaccination effort. The World Health Organization, as well as its partners, has formulated a way of helping South America respond to the problem of yellow fever. The Yellow Fever Strategic Framework builds upon the Yellow Fever investment case strategy, which has reduced the frequency and size of disruptive yellow fever outbreaks. It prioritizes endemic countries according to their epidemic risk so that allocation of vaccine and resources can be quickly undertaken when countries request assistance. This enables the World Health Organization (and partners) to identify populations of high priority. The World Health Organization is also trying to implement immunization campaigns to populations living in the greatest risk of yellow fever. This concentration allows the World Health Organization to optimize limited resources. Because yellow fever varies depending on which country in South America one is referring to, it is beneficial to examine a few countries in which the disease is prevalent to get a good understanding of why it is so problematic. Paraguay reflects a “transitional” country, demonstrating how rapidly the status of yellow fever can change within a specified country.1 Prior to 2008, Paraguay had not reported any cases of yellow fever since 1974. However, during late 2007, an epizootic started in Brazil, with expansion of yellow fever from southern Brazil into the rural areas of Paraguay. Additionally, there were several cases of urban yellow fever. This led to an intensive control and vaccination campaign with more than 1.5 million doses of vaccine administered. Driving forces for the reappearance of yellow fever infection, like in this case, are not clear to people in the medical sphere. •♥• i. World Health Organization. “Yellow Fever.” World Health Organization. World Health Organization, May 2013. Web. 10 Nov. 2013. www.who.int/mediacentre/factsheets/fs100/en/ ii. Maps of the World. “South American Economy.” Maps of the World. Maps of the World, 2012. Web. 10 Nov. 2013. www.mapsofworld.com/south-america/economy/ iii. Dorst, Jean P and C.W. Minkel. “South America.” Encyclopaedia Britannica. Encyclopaedia Britannica Online Academic Edition. Encyclopædia Britannica Inc., 2013. Web. 10 Nov. 2013. <http://www.britannica.com/EBchecked/topic/555844/South-America>. iv. South America, Central America and the Caribbean, in Europa World online. London, Routledge. Williams College Library. Retrieved 11 November 2013 from http://www.europaworld.com/entry/sacac v. "Yellow fever in Africa and South America, 2011-2012/Fievre jaune en Afrique et en Amerique du Sud, 2011-2012." Weekly Epidemiological Record 88.28 (2013): 285+. Expanded Academic ASAP. Web. 10 Nov. 2013. vi. Hill, David R. “Mapping the Risk of Yellow Fever.” Tropical and Travel Medicine. Tropical and Travel 10 Magazine, 5 April 2012. Web. 10 Nov. 2013


Return of Poliomyelitis The fight against Polio is not yet over -

By: Katherine Arellano (’16) POLIOMYELITIS, OR MORE WIDELY recognized as polio, is a viral disease that is often passed on from host to host via a fecal-oral route. Polio is often found in fecal particles, and later introduced to another host via the oral cavity. Though at first this may seem uncommon, or rather elusive, there are many avenues in which this disease can easily find its way on to its next victim.

Some of these include the following:      

Contaminated water Oral to oral pathways Food that has been prepared around feces Disease-carrying insects, such as houseflies Lack of hygiene after having been in contact with feces Sexual behaviors that incorporate oral exposure with feces (i.e. coprophilia or anilingus)

Pressing Polio Threat Across European Countries

It is predicted that approximately 90 percent of infected individuals experience no symptoms. In rare cases, roughly one percent, the virus is able to enter the central nervous system, quickly paralyzing its victim within hours – causing irreversible harm. It comes to no surprise then, that for many years, poliomyelitis has been a feared disease – especially amongst children.

And so, when on October 29, 2013, the World Health Organization (WHO) confirmed and announced a polio outbreak across the Middle East, action needed to be taken – and fast. Thought to have originated from Pakistan, the polio outbreak in war-torn Syria has caused panic. Because of its civil war, vaccinations rates have dropped, placing high-risk groups, like children under five years old, at higher risk1. In an effort to hinder the progression of the silent transmission of polio, Syria has taken action. It has begun to administer the oral polio vaccine (OPV) to over two million children. And even though polio has found itself in the hands of Syria, there is no stopping the World Health Organization and the United Nations Children’s Fund (Unicef) from embarking on a campaign to help vaccinate neighboring countries as well2. As was, and is continued to be seen across countries, there exists a constant battle in fighting for preventative care across the world. There is a fight to obtain and deliver safe and effective immunizations to individuals, especially children, across borders. The fight is clearly not over3. •♥• 11

Nebehay, Stephanie. "Polio Outbreak in Syria Threatens Whole Region, WHO Says."Reuters. Thomson Reuters, 29 Oct. 2013. Web. 11 Nov. 2013. 2 Butler, Declan. "Polio Risk Looms over Europe." Nature.com. Nature Publishing Group, n.d. Web. 28 Nov. 2013. 3 Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 04 Nov. 2013. Web. 9 Nov. 2013. 1


THE PRICE TO PAY for the declining economy of the world’s smallest republic, Nauru, is obesity. The principal source of income for the republic, located in the South Pacific, Northeast of Australia, is the mining of phosphate. In the middle of the twentieth century, after the republic’s independence from Germany, Nauru had the highest GDP per capita in the world, but the depletion of the phosphate cash crop has vastly reduced the economy. There is not much phosphate left for excavation, and in addition to leaving the island with a lack of economic reserves, the mining is not sustainable for the soil of the island; the phosphates provide a superior ingredient for the fertilizers, yet once it has been expunged from its source it is not instantly replenished.

Instigating Health Awareness for Globesity: Education, Economics, and Ease of Access

The consequence of twenty-first century poverty has evolved as technology has allowed for the fight against hunger to be slowly conquered. The problem is inherent in the food that is accessible to the poor. Ongoing research at the Harvard Kennedy School of Government has concluded that socioeconomic level is often indicative of obesity; no longer is the image of the malnourished associated with the impoverished, but those who are at the other extreme of weight and nourishment. The obese are steadily becoming what one thinks of with poverty awareness. Children who are raised by parents with college educations are more likely to have an extended pallet for foods of high nutritional value, and participate in extracurricular activities that pertain to exercise. Children who live at or below the poverty level, are usually exposed to more processed foods, and do not have the opportunity to take part in daily exercise. In the United States, zones are outlined as food deserts if fresh produce is not within a few miles, and the inhabitants, with a lack of financial and educational resources, are subjected to food that is not beneficial for their health. Case studies, such as Nauru, illustrate that arguably the factor with the most weight is the financial impediment.

By: Logan Lawson (’16)

The financial deficit has allowed for obesity rates to skyrocket; 97 percent of the men and 93 percent of the women of Nauru are either obese or overweight. In the case of Nauru, fresh vegetables and fruits are not easily attained because of the infertile soil as a result of the mining of the phosphates. Most of the fruits and vegetables on the island are canned and refined, with awfully little access to whole foods teemed with the financial burdens that the people of Nauru are suffering. Food deserts in the United States suffer from a lack of financial resources and access to whole foods as well, but it is definitely on a different level than the situation in Nauru. By definition, food deserts are areas in which the majority of the people do not own a car and a supermarket is not within a mile; thirty percent or more of the inhabitants usually are at or below the poverty line, as well. In addition to the absence of supermarkets, fast food restaurants and corner stores are plentiful, allowing for people to become enticed by the low sale prices, and food that does not require much preparation. Again, there is not much access to whole foods and insufficient financial resources, but the United States as a nation is not Nauru; the U.S. is copious with farms in rural and urban locations, and the goal of allowing for each and every citizen to have access to a certain standard of healthy food is practicable. The responsibility of this food revolution is in the hands of people

Obesity rates of Nauru are rapidly increasing.

from all socioeconomic levels. What the nation consumes as a whole is indicative of what is accessible to the impoverished. Highly processed foods would not be donated to shelters, and organizations, like Food Share, if they were not purchased in the first place. Those at or below the poverty line in the United States are not in a deficit synonymous to those in Nauru. The United States has programs like SNAP (Supplemental Nutrition Program) and WIC (Women, Infants, and Children) to provide financial subsidizing for food, and what food the people demand should be accessible is dependent on education. Nutrition education can solve the setbacks in the United States and Nauru alike.

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1 American Nutrition Association. Nutrition Digest. Vol. 36, No. 3 “USDA Defines Food Deserts.” 2011. 2 Collins, Jennifer and Bentz, John. “Behavioral and Psychological Factors in Obesity” The Journal of Lancaster General Hospital. Winter 2009, Vol. 4, No. 4 3 Economy of Nauru. 4 Food Price Fears Prompt Obese Future: People opting for cheaper, less nutritious food. 5 Harvard School of Public Health. Obesity Prevention Source. 6 Laurance, Jeremy. “How tiny Nauru became the world’s fattest nation.” 2011.


Addressing the issue of obesity is not simple. The American Medical Association has categorized obesity as a disease. A subtle intersection of psychology, genetics, and environment is inherent to obesity, which allows for the complexity of the education that needs to be provided to those suffering and at risk. Psychological and environmental factors can be manipulated to allow for optimum health. Nutrition education is intrinsically psychological; countless programs across the United States aim to instigate awareness for what people should be eating to sustain healthy lives. Who is targeted within the programs though, is considerably correlated to success. Some programs are tailored for children, while others are for adults, but arguably, the ideal situation occurs when both the parent and child are receiving education. What is the use of educating a child on what he or she should eat, if at the end of the day it is up to the parents on what is being consumed in the household?

When healthy whole foods are available, the misconception that they are more expensive than fast food is false.

Interactive education involving transforming the environment into a sustainable living space has also been proved to work. Grass-roots environmentalism is on the rise to empower people to be a part of the agricultural component of the food system. Food trucks, markets, and restaurants serving fresh vegetables and fruits are also other means of providing whole foods access to food deserts and similar areas. Unfortunately, the people of Nauru cannot take part in agricultural processes due to the poor soil quality, and not every city has the resources for urban farming. Nevertheless, the implementation of small changes within the diets of community members, in addition to striving for more access to whole foods via other resources can go a long way. Anyone and everyone can get involved in this fight; we are slowly moving past hunger and commencing efforts to allow for more uniform access to food across socioeconomic levels. •♥•

7 Nauru Profile, BBC. 2014. 8 Nauru Food and Drink. 2014. 9 Pizzi, Michael. “World shifts focus to hidden hunger as global obesity expands.” 2014. 10 Pollack, Andrew “A.M.A. Recognizes Obesity as a Disease.” 2013. 11 TED Case Studies: Nauru. http://www1.american.edu/ted/NAURU.htm

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Conversely, if parents are educated on what should be purchased and eaten at home, yet, do not know how to accurately convey to their children why their eating habits should change - conflict will arise. There needs to be an understanding on both sides as to why certain foods should be opted for over others. The National Instituted of Health has recently developed a curriculum called Eat, Grow, Play that can supplement nutrition education that addresses the parent and student; with art activities, exercise, songs and dances for the students and well-defined handouts for parents, engaging families to learn the importance of leading healthy lifestyles. “Urban gardening involving participation by the inhabitants of the city are one way an atrisk environment can change to support a healthier lifestyle.”

Students and parents of Nauru learning in a classroom setting.


lack of proper medical care but high hopes for the future

IF YOU WERE TO WALK into my room, after stepping over my textbooks and warily eying my nearly overflowing laundry basket, you would find yourself staring at the wall beside my desk covered with photos of cocoabrown Zambian children – some unwell and wearing tattered garments, others smiling and playing. These children, along with my vivid memories of sick street children, too poor to receive adequate medical treatment, are my inspiration. Medical care and research - particularly in cancer - in Zambia is severely lacking. Zambia is a land-locked country located in southeast Africa. Despite its healthcare shortfalls, Zambia has a rich culture. The Zambian military helped the Allies in World War II by fighting in Burma - Zambia is the world’s 5th largest copper producer, and the country is one of Africa’s most urbanized.1 Unfortunately, like all countries, Zambia needs improvement in several areas – one of these is cancer care.

Though there are 14, 075, 000 residents living in Zambia, there is only one cancer hospital in the country.1 Various clinics and university medical centers do offer oncology services, but specialists are few and far between. The shortage of specialists is partly due to medical professionals leaving Zambia for improved economic conditions elsewhere. 2

This makes it particularly difficult for rural residents to access cancer care in a timely and effective manner. Thus, cancers that are treatable end up resulting in mortality for thousands of residents. If families are able to access treatment, many from poverty stricken regions find that the pressures of constant therapeutic sessions result in financial and economic stress.3 Some patients end up not finishing their treatments because they cannot afford to attend all treatment sessions.

The largest hospital in Zambia is the University Teaching Hospital. This hospital is one site that is able to offer comprehensive cancer care. Despite this resource, there is a nationwide 10% child-cancer survival rate.4 When compared to America’s 79.6% childhood cancer survival rate, Zambia’s rate is devastatingly low5. Several factors contribute to the lower rate: late diagnosis, abandonment of treatment, lack of oncology specialists, and inappropriate treatment protocols6.

Recognizing areas for improvement is the first step in decreasing cancer disparities. Several organizations in Zambia provide support to families battling cancer. The Zambian Childhood Cancer Foundation (ZACCAF) mediates support groups for poor patients, where parents can receive assistance. The University Teaching Hospital has partnered with The Children’s Hospital, Oxford to facilitate training in Zambia that will promote quality cancer care and equip Zambian health professionals with the tools needed to increase cancer survival rates7. The future is looking brighter for Zambia, but many residents are needlessly dying. An increase in global cancer research will benefit not only Zambia, but also other developing 14 nations seeking locally appropriate treatment protocols. •♥•

The Zambian Childhood Cancer Foundation sponsors a holiday celebration for children with cancer


Cancer care in Zambia WORK CITED

"Interesting Facts." ACTION Zambia Ministries RSS. N.p., n.d. Web. 16 Jan. 2014. Health Observatory Data Repository." African Region: Zambia Statistics Summary (2002. N.p., n.d. Web. 20 Oct. 2013. 1 Mutale, Wilbroad. "Measuring Health Workers' Motivation in Rural Health Facilities: Baseline Results from Three Study Districts in Zambia Springer." Measuring Health Workers' Motivation in Rural Health Facilities: Baseline Results from Three Study Districts in Zambia - Springer. N.p., 01 Feb. 2013. Web. 21 Oct. 2013. 1 Zaccaf. N.p., n.d. Web. 16 Jan. 2014. <http://www.zaccaf.org/about-us/>. 1 "Oxford-UTH Partnership." THET. N.p., n.d. Web. 16 Jan. 2014. 1 Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute. 7 Friedrichsdorf, Stefan. "Teaching Pediatric Pain Management in Zambia: Has Pediatric Cancer Been Forgotten in Africa?" Kids Health. N.p., n.d. Web. 16 Jan. 2014. 1

1 . "Global

Access to Antiretroviral Therapy in Developing Countries in the Fight against HIV/AIDS by: Kimberly Kiplagat (’16)

A map depicting the global HIV/AIDS epidemic amongst adults

THE HISTORY OF HIV/AIDS is suspected to have started in the ‘60s and ‘70s, However, it was not until the late ‘70s to ‘80s that the medical community was aware of it. (1). In 1981, doctors were concerned by the growing number of healthy young people developing Kaposi’s Sarcoma (a type of cancer) and Pneumocytisis carinii (pneumomia). This was puzzling because it was usually diagnosed in people with weakened immune systems.(1) The emergence of this virus is thought to have originated from chimpanzees in Africa and the virus mutated and went on to affect humans. In July 1982, the name AIDS (Acquired Immune Deficiency Syndrome) was given to this disease. (1) HIV/AIDS can be transmitted through: sexual contact, pregnancy, childbirth, breastfeeding, injection drug use, occupational exposure, and blood transfusion/organ transplant. (7) HIV virus lives and reproduces in blood and bodily fluids. The bodily fluids that contain high levels of HIV include: blood, semen, pre-semen, vaginal fluids and rectal mucous. (6) 15


Prevalence of HIV/AIDS can be fueled by socioeconomic challenges that are a great concern in developing countries. These factors include: poverty, discrimination, stigma, homophobia, increase of STDs and the lack of treatment thereof, low status of women, limited and uneven access to health care, and population mobility.(2)(3) South Africa currently has the largest population in the world suffering from HIV/AIDS. Sub-Saharan Africa accounts for 67 percent of all people living with HIV.(1) These factors above affect the everyday lives of people living with HIV in developing countries. First, stigma and denial lead to late diagnosing and the progression of HIV/AIDS. Secondly, poverty leads to poor nutrition which plays a major role in the onset of the illness. Limited access to clinics and treatment plans are also a huge factor that impacts those living with HIV.(4)

The treatment plan today for HIV/AIDS is antiretroviral therapy, which is a combination of at least three ARV drugs given to combat the virus. The World Health Organization (WHO) and UNAIDS estimated that 10 million people had access to treatment in 2012, compared to 8.7 million people in 2011, an increase in over 1 million people in only a year. (3) Although, this is a great improvement, there are still ways to go in providing ARVs to affected individuals. The Executive Director of UNAIDS, Michel Sidebe, believes “it is our moral and scientific obligation to reach as many people as we can with antiretroviral therapy. UNAIDS believes that the expansion of treatment can be achieved with cost saving efforts, such as reduction in cost of medicines and medical supplies, simplifying delivery systems, and increasing efficiencies in AIDS response (3)

Antiretroviral Therapy Medication

Another proposed solution is to promote community based organizations (CBOs). The role that CBOs play is to provide support for rural communities who bear the burden of taking care of those ill and no longer able to work because of HIV/AIDS.(4) Community based organizations will aim to educate the community members on the importance of early diagnosis which leads to a better prognosis achieved with antiretroviral therapy(4). Dr. Gottfried Hirnschall, Director of the HIV department at WHO asserts, “When people take antiretrovirals, the amount of HIV in their bodies is decreased. If we can get, and keep, more people on treatment, and reduce their virus levels, we can reduce the number of new people who are infected.”(6) The importance of education in treating those infected with HIV/AIDS and preventing new infections cannot be overemphasized. The stigma that still exists along with the various socioeconomic challenges continues to be a great challenge in providing the treatment needed, especially in developing countries. Thanks to the improving technology and science research, the antiretroviral therapy has proved to be vital in enabling those infected with HIV to live a normal, healthy life. It is possible that many lives will be saved if we continue on in making good strides to provide antiretroviral therapy to those who need it in order to survive. •♥•

1. 2. 3.

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4. 5. 6.

Mandal, Ananya. "History of AIDS." History of AIDS. News Medical, n.d. Web. 25 Jan. 2014. "Socioeconomic Factors Affecting HIV Risk." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 15 July 2013. Web. 26 Jan. 2014. Barton-Knott, Sophie. "Press Release." Around 10 Million People Living with HIV Now Have Access to Antiretroviral Treatment. N.p., 30 June 2013. Web. 26 Jan. 2014. "HIV/AIDS in South Africa." AIDS Foundation of South Africa. N.p., n.d. Web. 23 Jan. 2014. "'Strategic Use' of HIV Medicines Could Help End Transmission of Virus." WHO. WHO, 18 July 2012. Web. 26 Jan. 2014. "How Do You Get HIV or AIDS?" How Do You Get HIV or AIDS? AIDS.gov, n.d. Web. 23 Jan. 2014.


Sweden’s Healthcare System: Why it Matters By: Heather Biehl (’14)

SCANDINAVIA IS FREQUENTLY REGARDED as a global exemplar in public health. For example, Sweden was ranked 23rd out of 191 states in the World Health Organization’s last ranking of health system efficiency in 2000.1 The nation has, since the 1946 passage of the National Health Insurance Act, provided publicly financed universal coverage to all citizens.1 Overarching health system objectives are determined by the central government, while local governments dictate specific service deliveries and county-level tax levies. Taxation funds primary health care, hospital care, home care, and prescription drugs, while specialist services are, in most regions, gated. For example, secondary and tertiary care requires the referral of a general practitioner. Finally, Socialstyrelsen, the National Board of Health and Welfare, supervises service quality and efficiency and provides informational support across governmental divisions.1 Despite universal coverage, a cost-efficient gated division of care, and the general social and economic provisions of the welfare state, inequality is not absent from Sweden. Disparities are particularly relevant with respect to regional and socioeconomic divisions. Beginning in the 1960s, liberal immigration policies attracted an influx of immigrants, particularly from middle-eastern countries such as Iraq and Iran: 15% of Swedes are now foreign-born, and 20% of Swedish citizens are born to two foreign parents.1 The government’s Million Program housing initiative was a response to the influx. It funded cinderblock-style apartments surrounding Malmö and Stockholm, providing affordable housing to incoming population. This housing initiative also simultaneously facilitated the visible segregation of foreign populations to suburban regions. These Million Program Areas have lower occupation rates, education levels, and political participation, and a conversely higher reliance on social benefit. Foreign-born people in these areas, particularly women and the elderly, are at increased risk of ill health and are more likely to avoid seeking care due to financial constraints.1 Differential public health statistics have been documented in Sweden despite purported universal coverage. Such disparities raise questions regarding the oft-observed disconnect between healthcare policy and health service uptake. It seems that for Sweden the existence of universal coverage makes no guarantees concerning the quality, effectiveness, or equitable distribution of healthcare services. As a 2013 summer research fellow in Sweden, I was able to observe several examples of locally based health system inequalities. Most primary care clinics, or Vårdcentralen, are located in urban centers, and many Million Program Areas contain a single Vårdcentral responsible for service provision to the large immigrant population. Resources are often allocated to large urban clinics, leaving suburban clinics underfunded and overworked. Wait times are long and appointments are brief, an effect amplified by a lack of multilingual physicians. Communication, according to Vårdcentral, poses a significant hurdle--individual appointments, as well as the health system at large, may be difficult for patients lacking Swedish language abilities to navigate.

Political scientists have often proposed that health is a function of a society’s social cohesion. Sweden has, for many years, been an ethnically homogenous society; a tribe-like national consciousness may have facilitated the institution and maintenance of the welfare state and, therefore, the provision of publicly funded universal healthcare. Increasing diversification, however, has applied pressure to the Swedish state’s established healthcare system. A recent political advertisement exemplified the anxiety of Swedish conservatives regarding such challenges: it depicted an elderly Swedish woman bowled roughly aside by a pack of burqa-clad women in pursuit of a welfare check.1 Documented socioeconomic disparities in Sweden prompt us to consider the challenges that progressive globalization may pose to the health of populations worldwide. Considerations of cultural sensitivity and intra-state equality will be at the forefront of global health in coming decades. •♥•

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Global vol 1, issue 1: the official magazine of Williams College Initiative for Global Health  

Read our first issue of our magazine on current global health issues and become aware of what diseases are still affecting people around the...