FORGING THE CHAIN

NEGLECT:
A BROKEN CHAIN
Neglect: The Latin words negligere mean “detached” or
“disrupted”. The opposite is religere, or re-linking – as
one would do with a broken chain – or “bringing all together,”
a good definition of teamwork.
Over the years, tropical diseases have caused hundreds
of thousands of deaths, immense suffering and
permanent disability.
It is surprising that they have not received as much
attention from the international and medical communities
until now.
The term neglected tropical disease was not
coined out of thin air. It is linked to a group of specific
diseases characterized by poverty and remote inaccessible
areas. These features lend themselves to
neglect and breaks in the links of the chain providing
access to health care.
For the chain to function a number of crucial links
have to be created.
For a medicine to be provided to a patient in such
a situation at an affordable cost – or at no cost, in
most cases – a great deal must be done beforehand.
And no link in this chain of access is forged easily. For
example, the medicine has to be produced, shipped,
imported, distributed and delivered. The location concerned
can make “the middle of nowhere” sound like
a euphemism.
A doctor or, at least, a qualified nurse, must be
available to administer the treatment correctly.
Generally, some kind of supporting structure is
necessary, such as a refrigerator to keep the medication
at a suitable temperature, a generator to power
the refrigerator, and equipment and chemicals to
ensure sterile conditions.
Before that, a diagnosis must be made. In many cases,
that means a diagnostic test has to be transported,
used and the results interpreted, often in a laboratory.
Earlier still, the patient must decide that whatever
is wrong is worth medical attention. That is a significant
factor. Seeking treatment may mean losing a
day’s work at subsistence farming. Or spending (or
borrowing) money needed for other things to travel to
the nearest health clinic. Because many tropical diseases
are best treated early, but may have benign or
ambiguous symptoms, people in rural, isolated communities
frequently must be educated about what to
look for. Often even this is not enough, and mobile
medical teams must pass through the area, actively
screening for infections.
Of course, medicines and diagnostic tests have to
be developed to begin with. For tropical diseases that
largely affect the poor, that means the wider world has
to notice there is a problem in the first place and must
donate funding to deal with it.
Several of these tropical diseases have caused
hundreds of thousands of deaths over the years, enormous
suffering and permanent disability. There have
always been breaks in this chain of access.
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