My Pet Parasites

I have an amoeba! Or perhaps a protozoa! (Probably many of them, in fact.)

Just last week, my husband and I returned from an extended vacation in the Himalayas, where our friend Luke is doing his research on the temple town of Kedarnath. We had the amazing experience of walking with the three-day procession that takes the temple’s diety back from its winter home in the comparatively warm Ukhimath up to Kedarnath, its usual place of residence. Yes, three days, about 26 miles, an increase of something like 7,000 feet in elevation. Over roads, paved trails, dusty slopes. Through towns filled with hundreds of singing, uniformed schoolkids and villages where a handful of women would toss flowers on our diety, say prayers, offer tea, while still finding time to help whittle my walking stick with a sickle.

And along the way I seem to have picked up my first parasite. As a science geek, I was all excited to look up giardiasis and other options. One of the things that worried me, though, as I got more and more fatigued just sitting around back in our Delhi apartment day after day, was the fact that diagnosis required many days of turning in samples. This prospect was pretty daunting, considering it would mean wandering around in 108 degree weather!

I need not have feared.

Yesterday, I went to our neighborhood doctor (who actually specializes in cardiology but seems to treat everything, including the minor dog bite I had two months ago). He asked a few questions, poked me in the belly a few times, and that was that. Rather than try to pinpoint my exact invader (with most likely dubious lab support to analyze tests), he just gave me something that kills EVERYTHING. Bacteria…protozoa…And then he prescribed some nice acidopholis to keep my tummy inhabited by the good stuff.

The verdict: “Yes, it’s some sort of amoeba, maybe giardia.” Which is extra-curious, cause giardia is a flagellate (it has a tail), not an amoeba.

But whatever.

Usually I’m the type to analyze every med I’m given, but here the Internet proves useless. I’m taking ornidazole/ofloxacin, a potent combination that appears to be sold only in India. At first this seems rash, but in a place where proper diagnosis may be impossible, the approach makes sense. Why waste time on particulars, if the particulars may never come?

So far, so good. I’m feeling better already, not still like I’m about to faint any minute. My only regret is that I won’t one day be able to reminisce with the help of my own giardia toy.

giardia

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Makes me want to go back to grad school…

And become an epidemiologist. Maybe it’s just the rock ‘n’ roll I’m listening to (Patti Smith, in fact) while I read, but I am incredibly awed at how brave the researchers are who conducted the civilian mortality study on Iraq that came out last year. Both the door-to-door surveyors and those who went through so much careful planning, all the while knowing that every word and idea they put on paper would probably be turned against them.

To read what I’m reading, link to the article in Johns Hopkins Magazine.

One question I really want answered: In the description below, who was Roberts most afraid of? The US-led military, angry Iraqis, who? To slip into a country in such a way indicates great fear. But of what, whom?

In September 2004, Roberts [epidemiologist, lead researcher on the study] packed $20,000 in his shoes and a money belt and, lying on the floor of an SUV, slipped into Iraq from Jordan to coordinate the data gathering.

What exactly is “social business”?

To be honest, I’m more of a medical and public health person, but these areas increasingly seem to overlap with finance, insurance, and other business-related fields. I’m slowly trying to learn about such things, which are often counterintuitive to me.

So last week, I was very excited to be able to attend a lecture by Muhammad Yunus of Nobel prize and microcredit fame. It was sponsored by FICCI, the same Indian chambers of commerce group that co-hosted the microhealth insurance conference I wrote about back in November.

I don’t think Yunus said much in his talk that he hasn’t publicly said already, but much of it was new to me. He seems to be trying very hard to promote the concept of “social business,” even to the point that the term comes across as a brand name.

The way I understand it, social business is a way for companies to conduct business that benefits the poor, with the main rule being that they can’t turn a profit. A company can break even, but isn’t allowed to recoup any money beyond its initial investment. It must also keep such projects financially separate from any profit-seeking ventures, in order to avoid conflicts of interest.

Yunus’ main example was an agreement he says Grameen Bank, his microcredit organization, has made with the French corporation Danon to manufacture nutrient-fortified yogurt for children in Bangladesh. The plan is for Danon to build a yogurt factory and then sell the product at above cost until it pays for its investment. Interestingly, the yogurt will not even be marked with the Danon logo, because Yunus fears this would cause the food to become a status item sought out by brand-savvy people and lead to shortages.

In a quick Google search, I couldn’t find many details about the Grameen Danon partnership.

This leaves me with several questions: After Danon makes back its money, then what? Will the yogurt drop in price? Or will the profits be used to fund additional projects that benefit the poor? Most importantly, what does Danon get out of this? Financially, legally, etc., how does this differ from donations to charity that can be tax write-offs? What motivates the company to take on the risk of creating the infrastructure to produce and distribute this product?

Making Meds in India

For the past several years, I’ve been following the news of how India’s pharmaceutical patent laws are gradually changing. What sometimes reads as pure legalese actually has far-reaching implications, because many of the medicines that treat poor people around the world are made here at low cost. But last year, India’s government moved to restrict their dynamic pharmaceutical industry.

I’ve always had it in the back of my mind that I should write a story that pulls everything together: the personalities, legislation, science, business, etc., rolled into one package that explains it all. Well, Erika Check beat me to it in her recent Wired magazine piece. Excellent work!

Micro Health Insurance Hedges Risk for India’s Poorest

After attending a conference on micro health insurance in Delhi last week, I wrote this story for the Christian Science Monitor. Interesting stuff.

All the community-based groups providing the insurance plans seem to be doing remarkably well, but like almost everyone I talked to, I’m wondering how long this movement can last in micro form. If the Indian government increases their regulation of micro insurance, it may be hard for the smaller groups to prove their financial stability and expertise. If this idea becomes a well-known success story, large companies may be tempted to see how they can profit.

And, as Mukti Bosco of Healing Fields Foundation points out: insurance alone cannot cure the ills of India’s health system. Even with the best of insurance plans, rural people may not be able to find competent doctors or well-equipped clinics near their villages.

Healing Fields

In Andhra Pradesh, a Healing Fields hospital facilitator (right) helps a woman speak with her doctor. (Photo credit: Healing Fields Foundation)

Long time no blog

Well, three weeks later, here we are! I thought about adjusting the date of my original post, but that would be oh so dishonest. I’ll just pick up where I left off, I guess.

The big news around here is dengue, though it looks as if the mini-epidemic may be waning. Dengue, caused by four closely related viruses, is carried by the Aedes aegypti mosquito. From what I gather, it’s an unusual mosquito-borne disease in that that its carriers thrive in an urban environment, don’t need murky water to live, and bite mainly during the day. Most cases of dengue are rather uneventful; if you catch only one virus subtype at once, you have flu-like symptoms, pain behind the eyes, and bone pain. But catch one or more in quick succession and there’s trouble: possible hemmorhaging and death. With proper medical treatment, only 1% of those with the severe dengue die. In India’s current outbreak, nearly 6,000 people have been infected and over 100 have died (according to National Geographic news)

My friends and I have been pretty concerned about this (though to be honest the nervousness is wearing off) because the epicenter of the outbreak occured at the All Indian Institute of Medical Studies (AIIMS), a nearby medical school and hospital. The word is that on-campus hygiene was so bad that the dengue mosquitos took over. This explanation kind of perplexes me, since the whole weirdness of Aedes mosquitos is that it doesn’t take standing dirty water to breed the things. But whatever. Point is, it’s awfully disconcerting to have medical students and doctors dying a mile or so away, and that the big plan was for most people in the city who had symptoms to go to AIIMS for testing.

I’m a little hazy on the logistics of how Delhi’s healthcare system handled the huge intake of patients, but this article in Frontline discusses some of the issues that dengue has exposed in the past two months.

In a related note: I learned recently from a 2002 World Bank report that approximately 25 percent of Indians who are hospitalized drop below the poverty line because of that hospitalization. Interestingly, despite the fact that that report is entirely focused on addressing the health needs of those Indians without much money, it is not available free online. $13 is a lot of rupees.