Commentary, Experiences, Learning, Platform

The Danger Of Playing Doctors

Back in March 2014 I caught malaria.

My host organization took me to a clinic for a test but it was closed so we went straight to the pharmacy and bought malaria treatment. From my previous 9 months experience in Africa I had found that most people self-diagnose malaria. I allowed myself to be self-diagnosed too.

I thought, “Well they certainly know more about malaria than me”.

The symptoms were pretty much like a flu, feeling unwell, vomiting, diarrhoea, but nothing too extreme. It lasted a week.

But now I know it wasn’t malaria. It was the acute infection, seroconversion or primary HIV infection phase which usually appears between the 2nd-4th weeks after the person has been infected with HIV.

One of the MDGs is about combating HIV/AIDS, malaria and other diseases. Some of the WHO recommended strategies for this MDG include diagnostics and treatment with quality-assured antimalarial medicines, tracking every malaria case in a surveillance system.

If people can get malaria treatment in the pharmacy without a test that confirms you actually have malaria, some real cases of malaria aren’t being reported properly. Treatment efficacy can also be reduced as a result of drug resistance.

After my experience of an erroneous malaria self-diagnosis finding out that I could get malaria treatment from the pharmacy just by saying, ‘hey, I am not feeling well, they think I have malaria,’ a few question comes to my mind:

  • Why did I follow self-diagnosis and self-treatment in Africa knowing the high prevalence of these diseases if I would never do it even with just the flu back home?
  • Is self-treating with anti-malarials as prevalent as taking, for example, an ibuprofen for a headache?
  • What are the regulations to sell medicines without medical prescription in Africa?
  • Are the drugs sold without prescription actually quality drugs?
  • Do they sell malaria medicine so easily because people can’t afford the cost of transport to a health facility or the tests once they’re there?*
  • Do they practice free malaria tests?
  • Are there any program focused in training pharmacist to advise about the importance of testing?

Until I was diagnosed with HIV I didn’t know about the acute infection. I think it should be an important concept when giving information about HIV as people in general could realize two things:

  1. Feeling unwell doesn’t always mean you have malaria.
  2. Infections have phases and symptoms, and so has HIV/AIDS. From a prevention phase with sexual education, used of condoms and pre-exposure prophylaxis (PrEP), to the different stages of the HIV infection.

Stages of HIV infection

stages-of-hiv-1LINKS: Post Exposure ProphylaxisAcute infection

stages-of-hiv-2

LINKS: Window periodELISAWestern Blot

stages-of-hiv-3LINKS: CD4Viral loadOpportunistic infections

After my time in Africa, and not because I thought I had contracted any disease, just as I always do after long periods abroad, I went for a general check-up.

Although I was feeling great and active, It didn’t surprise me to find that I had a deficiency in iron and vitamin B12, but then my doctor called me in to hear the other result:

“You have tested positive for HIV”

I still remember the scary feeling when I understood the meaning of my 274 CD4. Without specific antiretroviral treatment, people will progress from HIV to AIDS in a span of 8-12 years, but mine in 6 months were almost as little as 200.

18 days after I was diagnosed HIV positive, with CD4 of 274 and a viral load of 94.200 copies, I started my antiretroviral treatment. I take 3 tablets each morning at the same time (Prestiza Norvir, Kivexa). After 2 months under treatment my CD4 were 542 and my viral load 516 copies. In the doctor appointment after 4 months under treatment, my CD4 continued to increase, to 581, and I have undetectable levels of virus (<20 copies). My HIV specialist is aware of my plans to continue my aid career and has given me advice and recommendations and has approved for me to move back to Africa.

In 2015 HIV is a chronic disease for all who can access care and treatment. Going back to Africa will open a window to all of us interested in the real similarities and differences between being HIV positive in a developed country and in a developing one.

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* I went to the doctor/hospital on another occasion and whilst I mentioned that I had had unprotected sex, HIV was never mentioned nor a test recommended by the doctor. The costs of consultation, blood tests, surgery, anaesthesia, etc… would not have been affordable with my local salary. Luckily, medical travel insurance took care of it.
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Learning

Jeffrey Sachs Answered Questions On Reddit, Here Are The Highlights

Recently, the online community of Reddit provided us with yet another great opportunity to question one of today’s top minds in a social-convention-free zone. On January 15th, Jeffrey Sachs took part in an AMA (Ask Me Anything) session where hundreds of Reddit users were able to ask him educated and insightful questions about his work, beliefs, and opinions.

If you’re wondering what Sachs could possibly be doing on Reddit, or what Reddit even is, be sure to check out this great article by Rowan Emslie which should help to clear that up.

Part of Sachs’ motivation for doing the AMA was likely to promote his upcoming free online university course ‘The Age of Sustainable Development’. This 14-week course begins on January 21, and if your interested you can learn more or register for it here. Sachs encouraged many of those participating in the AMA to take the course and “join the generation-long quest to achieve sustainable development”.

For those of you who may not have the time to read this entire (rather long) article, here are some of the main takeaways from the AMA:

  • The importance of public health and environmental sustainability dominated the discussion
  • Sachs stood adamantly behind his views about foreign aid (as expected)
  • He often used the AMA as a vehicle to help plug his main causes and give them more exposure

Over the course of the AMA, Sachs also expressed his opinion on some topics you may have not expected, including the recently leaked draft of the TPP´s (Trans-Pacific Partnership) Environment Chapter, how automation and robotics will affect development, and even Sachs’ favourite novels. While these were definitely interesting insights, below I will focus mainly on recapping the main themes and top comments for anyone who missed the AMA.

What is Sustainable Development?

“We’ll discuss that at length in class. I am using the term “Sustainable Development,” meaning a holistic approach that combines economic, social, and environmental goals.”

Enough said. 

Global Health as the Key to Development

Public health and economic development have always been key components of Sachs’ policy and academic work. He makes it no secret that he views global health as the first stepping stone towards development.

Prioritizing development goals:

“I’d start with the health goals, since those are life and death. And then (or simultaneously) the hunger goal (obvious reason) and then education. Of course once people are alive and properly nourished, education becomes the KEY!”

On strategies to end poverty while increasing sustainable development:

“I think that the key to ending poverty and increasing sustainable development is “investment-led growth,” with investments in people (health, nutrition, education, training), plus investments in infrastructure (such as low-carbon energy), plus investments in “smart” systems using information technologies.”

The Great Aid Debate

As a champion of foreign aid and constant presence in the great aid debate, it was inevitable that the effectiveness of aid would be questioned and that some of Sachs’ top critics would come up in the discussion.

On Dambisa Moyo:

“Unlike Dambisa Moyo, I believe that aid is needed and can be organized effectively and respectfully. I am very happy with the successful scale up of aid for public health in the past decade. It has saved millions of lives and helped to promote economic development.”

Describing his relationship with William Easterly (with a passive aggressive smiley):

“There are days when I’m happier and days when I’m less happy. We’re colleagues and friends, but sometimes I’m simply amazed (and not happy) when he declares that “aid has failed.” This is simply NOT RIGHT!!! :-)”

On ‘The Great Escape’ by Angus Deaton:

“I did not agree with his very blanket statements against aid. In my view, such statements are contrary to the evidence. When somebody declares so categorically that all aid fails, raise your doubts. Such generalizations are not accurate. Much aid is very important. We need to understand why some aid succeeds and other aid fails, so that we can improve the design of aid programs.”

The Millennium Villages Project

The Millennium Villages Project has become one of Sachs’ most controversial endeavours, and has been the source of heavy criticism. This contentious debate arose following the first independent evaluation of one of the villages, and erupted in a series of online articles and duelling editorials. This past September, the commentary resurfaced with the release of Nina Munk’s book The Idealist: Jeffrey Sachs and the Quest to End Poverty. Despite this, Sachs is quick to challenge any criticism and stands firmly behind his project.

Sachs’ response to those who criticize the Millennium Villages Project:

“The project has had enormous positive impacts, way beyond the villages themselves. Governments have taken the successes of the villages as a basis for national policy, e.g. the control of malaria and the scale up of community health workers. There were originally 10 countries in the program, but its so useful for governments that the program is now operating directly or indirectly (through policy advice for example or as a template) in 23 countries. Please see www.millenniumvillages.org. By the way, there will be a comprehensive evaluation of the project, and a comparison with other places nearby, in 2015, to be reported in 2016. It will be interesting for all, including of course the project participants, to learn from these results!”

On the Millennium Villages Post-2015:

“The MVs will be evaluated at the end of 2015, and we will make course corrections and improvements as needed in several national programs underway to scale up the MV model. So the basic notion of using community-based rural development will continue past 2015, for sure. It’s working in many powerful ways, but will have even clearer evidence in 2015 on many important detailed issues.”

The Global Fund

In 2000, Sachs worked with then UN Secretary-General Kofi Annan to design and launch the Global Fund to Fight AIDS, TB, and Malaria and has worked to support the organization ever since. Last month, Sachs called to task many developed countries for failing to come up with the necessary $5 billion to maintain the momentum of the Fund. He continued his campaign to gain support for the Fund through his AMA.

On using empirical studies to evaluate aid programs:

“We need to be smart in our aid policies, using knowledge, experience, and EXPERTISE outside of economics (such as in public health). The Global Fund to Fight AIDS, TB, and Malaria, and GAVI are examples of aid success. We should measure and evaluate programs, but use methods that are appropriate to the circumstances. There is too much of a one-size-fits-all strategy to evaluation these days (too much on randomized trials, excluding other means of evaluation).”

On the continuation of the Global Fund agenda:

“The Global Fund is still trying to close the $5 billion. I’ll be speaking with several governments over the next few weeks as well to help close the deal. The name of the game is PERSISTENCE. It takes time to convince governments!!!”

On getting governments to work in the interest of their people:

“I believe that aid can be designed in ways that promote accountability and transparency. This is how the Global Fund has worked most of the time. It’s been a good and successful model. Yes, we should promote a high degree of transparency. Remember that much of the corruption starts from the side of the rich countries and their companies.”

Throughout the AMA, Sachs maintained his idealistic persona and most of his responses had an upbeat tone to them. While he frequently spoke about the success of his projects, he often rebuffed any commenter who brought up critiques of his work. One thing that I found particularly interesting was that Sachs often lumped those who disagreed with his work into the same category as those who simply didn’t ‘understand’ or ‘get’ his work and ideas. A little condescending don’t you think? That being said, what really shined through for me was Sachs’ talent as a campaigner, as it’s undeniable that he is quite effective at garnering support and drawing attention to his principle causes.

So what did you think of Sachs’ AMA? I’d be interested in hearing your thoughts in the comments section below!

Editor’s Note: Two of our new writers – Michelle Gonzalez Amador and Holly Narey – are taking Jeffrey Sachs’ new online course and will be blogging about their experience. We’ll be using the tag ‘Age of Sustainable Development’ for all these posts so check back on that in the coming weeks for more.

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