- Email: [email protected]
The deadly combination
Media Watch
cannot be made; they might arrive from resource-poor countries with poorly developed health systems, or—as is being seen more frequently in Europe—from richer nations. Additionally, the health needs of migrants will change over time, and will be dependent on both their past experiences in countries of origin, as well as the conditions in which they live in their host country. Refugees, for example, are identified as a potentially vulnerable migrant group, who may have previously been victims of torture or abuse and often face uncertainty and poverty in their host country— all of which will affect health status. The authors have done a commendable job in covering all of the bases. Although US focused, the information provided in Immigrant medicine has wider relevance to clinicians in any resource-rich setting, and has been compiled by key researchers and academics with international experience. The book comprehensively covers cultural competency, chronic illnesses, and mental illness. Particularly valuable contributions from the Centers for Disease Control and Prevention (Atlanta, GA, USA) and the International Organization for Migration (Geneva, Switzerland) include international screening protocols and best-practice guidelines for addressing communicable diseases in new arrivals. However, to what extent governments— who are increasingly restricting access to free health
care for certain migrant groups—would adopt such a comprehensive approach for new arrival screening remains questionable. Many European countries, for example, still struggle to run basic functional tuberculosis screening programmes for new arrivals from high-risk countries, let alone anything else. Either way, it is a step forward to have all this new information in one place; the free CD-ROM that accompanies the book is a particularly welcome addition. Whereas vast improvements in global health funding and research—offering substantial benefits to some migrants’ countries of origin—have been seen in the past decade, most western governments still fail to make the fundamental link between these beneficiaries and the needs of migrants in their own backyards. Nowhere is this contradiction more acute than in the case of HIV; vulnerable migrants are increasingly restricted from access to affordable and appropriate HIV/AIDS services in western health-care facilities. This situation needs to change, for such oversights fail everyone.
Sally Hargreaves, The Lancet Infectious Diseases SH is an honorary research fellow at the International Health Unit, Imperial College London, UK. This book is published by Elsevier, of which The Lancet Infectious Diseases is part.
Rockhopper TV
Film The deadly combination
This film can be viewed at either http://www.rockhopper.tv/ programmes/197 or http:// bbcworldnews.survival.tv, as can other episodes in the Survivor series
88
The deadly combination is the sixth episode in the Survival documentary season produced by Rockhopper films for BBC World News. The series addresses issues in global health care. Other episodes focus on sleeping sickness, drug distribution, pneumonia, and hookworm. All can be viewed online. The deadly combination explores the terrible effect of tuberculosis on modern-day South Africa. South Africa, this sombre documentary explains, has the highest rate of tuberculosis in the world. There are 100 000 cases per year; it has been declared a national emergency. But in the early 1990s, points out one doctor, tuberculosis seemed to be on the wane. “HIV changed all that”, he says sadly. By 2004, hospitals in KwaZulu-Natal Province—which has South Africa’s highest rate of HIV infection, and one-third of the country’s tuberculosis cases—were no longer able to admit tuberculosis patients for the 6 months that they had previously allowed for recovery. The period was reduced to 2 months, and then to outpatient care. Families are warned to minimise contact with infected relatives, and to ensure that they sleep separately, but it is hardly an ideal situation. Once patients stop feeling ill, they often cease taking their medication—relapses are common. We see
health-care providers monitoring patients swallowing antituberculosis tablets, but often patients simply stop turning up. Besides, an estimated 30% of individuals with tuberculosis haven’t even been diagnosed. All of which has led to the emergence of multidrug-resistant and extensively drug-resistant (XDR) strains of the disease. We meet Zelda Hansen, detained within the barbedwire enclosed Jose Pearson Hospital in the Eastern Cape Province. Isolated so as to prevent the spread of XDR tuberculosis for which she has tested positive but only shows few symptoms, Zelda escapes one Christmas to visit her family. The film paints a picture of a health-care system under enormous strain, with new obstacles appearing with alarming regularity. The disease’s spread has been facilitated by widespread ignorance and poverty, by the cramped conditions of the country’s townships, and the weakened resistance of the populace, thanks to the concomitant HIV/AIDS epidemic. A deadly combination indeed.
Talha Burki [email protected]
www.thelancet.com/infection Vol 9 February 2009
cannot be made; they might arrive from resource-poor countries with poorly developed health systems, or—as is being seen more frequently in Europe—from richer nations. Additionally, the health needs of migrants will change over time, and will be dependent on both their past experiences in countries of origin, as well as the conditions in which they live in their host country. Refugees, for example, are identified as a potentially vulnerable migrant group, who may have previously been victims of torture or abuse and often face uncertainty and poverty in their host country— all of which will affect health status. The authors have done a commendable job in covering all of the bases. Although US focused, the information provided in Immigrant medicine has wider relevance to clinicians in any resource-rich setting, and has been compiled by key researchers and academics with international experience. The book comprehensively covers cultural competency, chronic illnesses, and mental illness. Particularly valuable contributions from the Centers for Disease Control and Prevention (Atlanta, GA, USA) and the International Organization for Migration (Geneva, Switzerland) include international screening protocols and best-practice guidelines for addressing communicable diseases in new arrivals. However, to what extent governments— who are increasingly restricting access to free health
care for certain migrant groups—would adopt such a comprehensive approach for new arrival screening remains questionable. Many European countries, for example, still struggle to run basic functional tuberculosis screening programmes for new arrivals from high-risk countries, let alone anything else. Either way, it is a step forward to have all this new information in one place; the free CD-ROM that accompanies the book is a particularly welcome addition. Whereas vast improvements in global health funding and research—offering substantial benefits to some migrants’ countries of origin—have been seen in the past decade, most western governments still fail to make the fundamental link between these beneficiaries and the needs of migrants in their own backyards. Nowhere is this contradiction more acute than in the case of HIV; vulnerable migrants are increasingly restricted from access to affordable and appropriate HIV/AIDS services in western health-care facilities. This situation needs to change, for such oversights fail everyone.
Sally Hargreaves, The Lancet Infectious Diseases SH is an honorary research fellow at the International Health Unit, Imperial College London, UK. This book is published by Elsevier, of which The Lancet Infectious Diseases is part.
Rockhopper TV
Film The deadly combination
This film can be viewed at either http://www.rockhopper.tv/ programmes/197 or http:// bbcworldnews.survival.tv, as can other episodes in the Survivor series
88
The deadly combination is the sixth episode in the Survival documentary season produced by Rockhopper films for BBC World News. The series addresses issues in global health care. Other episodes focus on sleeping sickness, drug distribution, pneumonia, and hookworm. All can be viewed online. The deadly combination explores the terrible effect of tuberculosis on modern-day South Africa. South Africa, this sombre documentary explains, has the highest rate of tuberculosis in the world. There are 100 000 cases per year; it has been declared a national emergency. But in the early 1990s, points out one doctor, tuberculosis seemed to be on the wane. “HIV changed all that”, he says sadly. By 2004, hospitals in KwaZulu-Natal Province—which has South Africa’s highest rate of HIV infection, and one-third of the country’s tuberculosis cases—were no longer able to admit tuberculosis patients for the 6 months that they had previously allowed for recovery. The period was reduced to 2 months, and then to outpatient care. Families are warned to minimise contact with infected relatives, and to ensure that they sleep separately, but it is hardly an ideal situation. Once patients stop feeling ill, they often cease taking their medication—relapses are common. We see
health-care providers monitoring patients swallowing antituberculosis tablets, but often patients simply stop turning up. Besides, an estimated 30% of individuals with tuberculosis haven’t even been diagnosed. All of which has led to the emergence of multidrug-resistant and extensively drug-resistant (XDR) strains of the disease. We meet Zelda Hansen, detained within the barbedwire enclosed Jose Pearson Hospital in the Eastern Cape Province. Isolated so as to prevent the spread of XDR tuberculosis for which she has tested positive but only shows few symptoms, Zelda escapes one Christmas to visit her family. The film paints a picture of a health-care system under enormous strain, with new obstacles appearing with alarming regularity. The disease’s spread has been facilitated by widespread ignorance and poverty, by the cramped conditions of the country’s townships, and the weakened resistance of the populace, thanks to the concomitant HIV/AIDS epidemic. A deadly combination indeed.
Talha Burki [email protected]
www.thelancet.com/infection Vol 9 February 2009