FORGING THE CHAIN

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J JAMOT: <strong>THE</strong> DISCIPLINED ECCENTRIC The brutal toll taken by sleeping sickness a century ago led a French military physician named Eugène Jamot to devise a revolutionary approach. Jamot, who served with the French Colonial Army Health Corps, first in the region of the former colony of Oubangi- Chari and later in Cameroon, spent 22 years battling sleeping sickness. His philosophy was simple and innovative: “if patients can’t go to the hospital, the hospital must go to them”. His tactic – the use of mobile medical teams – is still employed today. Beginning in 1926, Jamot ran his programme as if it were a military campaign. It was vertically organized, disciplined, and imperative in character. Vigorous, systematic screening was carried out to detect early cases of sleeping sickness, and any cases discovered were treated immediately. The mobile teams used gland palpitation and gland puncture for diagnosis, and treated each positive case with injections of an arsenic derivative, a drug found to be effective and often used in combination with one of several other drugs. Jamot operated under three basic principles. The first was that everyone in a village or targeted region should be there the day a team visited – that is, case detection and treatment should cover the highest possible percentage of the population at risk. Second, the teams must be self-contained, independent, and all encompassing – they should include all the skilled personnel needed and all the equipment needed to do whatever was required. His third requirement was absolute autonomy of the sleeping-sickness service in technical, administrative and budgetary matters. Jamot had zero tolerance to interference and he made many enemies. His approach, however, was effective. The prevalence of the disease, that is, the percentage of people infected within a defined population, fell in Cameroon from 60% in 1919 to under 4% by 1930. Other colonial administrations took note. By the late 1960s, through work by mobile teams and aggressive vector-control campaigns, the reported percentage of sleeping sickness cases caused by the parasite T.b. gambiense in Africa had fallen to below 0.1% of the continent’s population. 61
K 62 KEY ACHIEVEMENTS CHAGAS DISEASE p71 “Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow.” William Pollard BURULI ULCER The past 10 years have seen major advances in the control and treatment of Buruli ulcer. Antibiotic therapy has revolutionized management of the disease. WHO, together with its partners, has guaranteed an uninterrupted supply of antibiotics to affected countries to ensure that all patients receive treatment free of charge. Diagnosis using polymerase chain reaction (PCR) has improved laboratory confirmation of cases. WHO has established a network of 17 laboratories in 14 countries to assist affected countries in confirming cases. A recent innovation – thin-layer chromatography to detect mycolactone – holds great promise for diagnosis in the field. The equipment is simple and inexpensive, and yields results within one hour. Surgical and rehabilitation skills have been enhanced in affected countries to ensure that those with complications receive adequate, high-quality care. Standard recording and reporting forms used in all endemic countries have improved surveillance of the disease. Finally, information, education and communication materials have been developed for use in all endemic countries for training and to raise awareness. Since the 1990s, great advances have been made in Latin America in interrupting vectorial transmission by the main domiciliary insect species, such as Rhodnius prolixus in Central America and Triatoma infestans in South America. This progress has been made through spraying homes with residual insecticides, improving dwellings (for example. by plastering cracks) and enhancing domestic hygiene to prevent vectorial infection. Universal blood screening to prevent transfusional transmission has been implemented in the 21 endemic Latin American countries, and in several disease non-endemic countries in Europe and the western Pacific. The launch by WHO in 2007 of the Non-Endemic Countries Initiative (NECI) continued to stimulate political impetus for the control and elimination of the disease and marked a historic signal for action in both disease-endemic and non-endemic countries. The adoption of a new WHA resolution, in 2010, updated strategy control taking into account all transmission routes and the need for care of millions of affected people, starting at primary health care level. It also promoted sustained control actions made possible thanks to the commitment of Member States, the strength of their research and control organizations, and support from many international partners. Implementing and monitoring blood screening to prevent infection through organ transplantation and diagnosis of infection in pregnant women, their newborns and siblings has been promoted and is being progressively implemented in disease endemic and non-endemic countries. The “tricycle strategy”, launched at the 2013 NECI meeting, stressed the need for programmes to be run with two “power wheels” (interrupting transmission and providing care in affected populations) and a “steering wheel” (an information and surveillance system). It also promoted an active strategy of diagnosis, treatment and interruption of transmission, and set up mechanisms to increase the visibility of the disease and of the people affected by it. The production of several information and training materials, the launch of the BeatChagas page and the design of courses to train health officials in the control of Chagas, in collaboration with new WHO collaborating centres, are examples of that the strategy.
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Acknowledgements Forging the chain:
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8 HAT ↓ HUMAN AFRICAN TRYPANOSOMI
Page 11 and 12: 10 PARTNERING IN THE BATTLE AGAINST
Page 13 and 14: 12 THE TERM “TROPICAL”: LEGENDS
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Page 21 and 22: 20 ACCESS TO HEALTH SYSTEMS ACCESS
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Page 41 and 42: D 40 DRUG DONATIONS VERSUS PREFEREN
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Page 57 and 58: H 56 HUMAN AFRICAN TRYPANOSOMIASIS
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Page 73 and 74: M 72 MAGIC AND DAMNED DISEASES: WHY
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Page 89 and 90: R 88 REACHING THE PATIENT: THE LONG
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Page 93 and 94: S 92 THE NEED TO REVISIT STRATEGIES
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Bibliography Dominican female study
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FORGING THE CHAIN

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