Global Health MD

Entries from November 2009

Breast Cancer in Developing Countries Needs a Customized Approach

November 16, 2009 · Leave a Comment

There are new guidelines published by the USPSTF to start screening women (at average risk) for breast cancer at the age of 50 (not 40 as is currently done). If we were to establish a set of screening guidelines for developing countries would we start at age 40 because the disease appears to be aggressive in this context or would we use data on cost effectiveness from the developed world and create a more conservative program that started screening at age 50?

The Lancet recently published an editorial on Breast Cancer in Developing Countries which describes the increasing burden of this disease on people in resource-poor settings. The article states that currently only 5% of global spending on cancer is aimed at developing countries.  This is worrisome given that “an estimated 1·7 million women will be diagnosed with breast cancer in 2020—a 26% increase from current levels—mostly in the developing world.” Yet the article explains that the WHO Commission has determined that most current strategies for breast cancer treatment and prevention in the developed world are not cost effective in the developing world.

In contrast, an article by the Breast Health Global Initiative states that “breast cancer outcomes in low- and middle-income countries (LMCs) correlate with the degree to which 1) cancers are detected at early stages, 2) newly detected cancers can be diagnosed correctly, and 3) appropriately selected multimodality treatment can be provided properly in a timely fashion.

There is clearly a major challenge that lies ahead – we have a growing problem in resource-poor setting and we won’t be able to export our solutions from the developed world to solve these issues. We will need to dig deep by chanelling research dollars to understand the nature of the disease in this context and develop a customized set of guidelines for the developing world.

Categories: Breast Cancer · Evidence-based public health · Uncategorized

How Medical Professionals Contribute to the Global Mental Health Crisis and How We Can Fix It

November 1, 2009 · Leave a Comment

A recent article in the Lancet claimed that global mental health needs attention.  It’s not hard to imagine -  if 40% of the world lives in extreme poverty on less than $2 per day, with limited access to basic health services, mental illness then sits at the bottom of the stack of future priorities.  As this article states, “the lives of individuals with mental illness exist under the worst of moral conditions.” The author, who has been involved in global mental health for four decades describes depressing scenarios …”appalling, dreadful, inhumane – the worst of words pile on each other to name the horror of being shunned, isolated and deprived of the most basic human rights…hidden by families, stoned by neighborhood children, treated without dignity, respect or protection by medical personnel.”

One of the major issues in dealing with mental health (in any part of the world) is the stigma associated with most psychiatric disorders.  In fact, mental health professionals and family members often promote these stigmas making it even more difficult to break the cycle. Addressing the issue of global mental health, the article argues, will require a moral transformation – giving social legitimacy to people suffering from a mental illness.

The article goes on to claim the state’s responsibility for protection of its citizens (under international law) which arguably should protect against this human tragedy.

Regardless of who we want to blame, addressing this global and tragic situation will require both civil and state response.  Those of us who are physicians, nurses or global health experts should advocate to bring more attention to mental health issues.

For example, we can advocate for a more robust, creative and effective curriculum to train health professionals. In my medical training, I remember finding it particularly boring, tedious and difficult to memorize the DSM IV criteria for the many psychiatric condition that ultimately I could barely tell apart.  In fact, I have subsequently found that the most effective way to teach the real impact of psychiatric disease is through narrative medicine – poetry, stories, or movies – that depict the mentally ill and bring the human spirit into the experience of these diseases.

We don’t need to tolerate the apparent apathy toward  global mental health.  For those unfortunate enough to live in poverty with a mental disorder, we can give them a voice by advocating to improve their moral conditions.  Improving medical education is just one small step we can take towards improving the global mental health crisis.

Categories: Mental Health · Uncategorized