Tropical healing - tackling disease in a world of global mobility

Lisa Mamone looks at the tropical disease burden impacting the developing world, and the training that's needed to equip health workers and researchers to tackle it.

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This article originally appeared in Voice, Volume 11 Number 6.
View the original here.

Lisa Mamone looks at the tropical disease burden impacting the developing world, and the training that's needed to equip health workers and researchers to tackle it.

The term tropical medicine is rooted in a tradition going back more than 100 years. It speaks of colonialism and otherness, of a world separate from clean, safe, industrialised society, when 'tropical diseases' were only found in the tropics.

But this is no longer the case – the world is smaller and the mobility of its people means diseases can travel further and faster than ever before.

Associate Professor Jim Black at the Nossal Institute for Global Health at the Melbourne School of Population and Global Health identifies limited resources and funds as the critical reason infectious diseases such as Ebola impact some nations more than others.

"Health services that don't have much money to spend really struggle," he says. "The impact of disease really does have a lot to do with how much the country can afford to put into its health services."

But Ebola is nowhere near the biggest killer in low-to-middle income countries, particularly of children. Neither is malaria, dengue fever, or tuberculosis, which are potentially fatal diseases with some strains becoming resistant to drugs and increasingly harder to treat.

According to the 2014 UNICEF report on child mortality, the most common cause of death in children under five years is pneumonia, which accounts for 18 per cent of deaths. While pneumonia itself is not a tropical disease, 95 per cent of cases are in the world's poorest regions – often due to under-nutrition, crowded housing and smoke from cooking fires.

But rates of pneumonia can be significantly reduced by ensuring all children have access to the measles vaccine. The World Health Organization reports a high percentage of children with measles, a preventable virus, develop bacterial pneumonia.

Treating disease in developing countries needs to be tackled on a number of evidence-based fronts underlined by an understanding of the environment in which it occurs, the pathology of the disease, availability and access to care, and reliable data collection on illness, births and deaths.

Building a better understanding of the current health problems in developing countries is something Professor Alan Lopez, also from the Melbourne School of Population and Global Health, is working on as part of the Bloomberg #DataForHealth Initiative. The initiative will improve health data in selected countries to better inform global and local policies.

"Anything we do that gives us a better understanding of what diseases are most prevalent, where they are and who's getting them has got be a good thing," Associate Professor Black says, about the initiative. "The places where the diseases are causing the most suffering are where you can find out the least about that disease."

Timothy Moore, who heads the Nossal's International Health Education and Learning Unit, agrees. "Many of the deaths caused by diseases are preventable," he says. "The challenge lies in mobilising resources and the securing the political will that's necessary to create change. Our students are going to be equipped with some of the skills to contribute to that."

The new Graduate Diploma of Tropical Medicine and Hygiene at the University of Melbourne is being delivered in partnership with Mahidol University in Thailand and the Burnet Institute. It teaches students the determinants of disease in developing countries, and the pathology and treatment of those diseases. The students spend four weeks in Thailand, in the provinces much of the time, to learn from real people with real diseases.

"When it's a far away country that you know nothing about and something strange is happening there, then it's easy to ignore it," Associate Professor Black says. "When you study tropical medicine, it opens up an understanding that the rest of the world is not all that far away."

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