In developed countries like the United States, where most of the events in this book take place, the miracles we witness as physicians typically involve individual patients. Yet in the developing world, where the needs of over-whelming numbers of people with devastating diseases are so great, the most effective type of health care is often that administered by global and public health providers who treat entire populations.
Two of the essays in this chapter are written by global health physicians describing miraculous encounters in their work that changed their lives, their careers, and their perspectives on health care in developing nations. The other essay is from a public health doctor fighting in the trenches of the AIDS war in Africa, where finding a way to sustain therapy for the neediest patients can require a miracle.
Date of event: 1988
The Miracle of a Single Sentence
Frank O. Richards Jr., MD
Once I was young and so unsure
I’d try any ill to find the cure
An old man told me
Tryin‘ to scold me
“Whoa, son, don’t wade too deep in Bitter Creek”
—The Eagles, Desperado album, 1973
I am a public health doctor, which means that my “patients” are entire communities and populations rather than individuals. Yet there was this poor old man living in the middle of nowhere who had one of the most significant and lasting impacts on my career and on my view of medicine. I think of him often, and I can see him as if it were yesterday. He helped me, scolded me, and also—perhaps—warned me about what I was wading into.
The setting was Guatemala in 1988. I was there as part of the public health team hoping to eradicate a parasite disease called “river blindness” or, more technically, onchocerciasis. Onchocerciasis is a leading cause of infection-
related blindness in the world. The worm that causes it (Onchocerca volvulus) is transmitted by bites of certain black flies, and at that time the disease was rampant in Guatemala. In fact, the country was the most affected in Latin America, and the area where I was working was the most affected area in Guatemala. Today, thanks to public and private health sector collaboration, Guatemala (and Latin America) is 95 percent of the way to reaching elimination of river blindness. That has been an important part of my life’s work.
. . . But I’m getting ahead of myself.
“Once I was young and so unsure
I’d try any ill to find the cure . . .”
A leading pharmaceutical company in 1987 had generously offered to donate a very effective medicine (tablets) to the world to eliminate river blindness. The idea is this: when a black fly vector (an insect that carries germs) bites an individual infected with the parasite, the fly can then transmit the parasite to the next individual it bites. Only humans carry the infection; if humans aren’t infected, the disease will perish. So the plan was to provide these tablets to treat everyone (known as mass drug administration) in the community older than age five years every six months to eliminate the parasite from their bodies and thus stop the spread. The treatments would have to be sustained for many years.
So in 1988 there were many questions about whether these poor and largely indigenous communities in Guatemala would accept the medicine. Working in developing countries, I’ve become accustomed to cultural differences that often impede the delivery of what the best-intentioned of us believe to be good practice. Issues of communication, trust, and education can be paramount. We needed to understand the people of these communities more fully to determine how to communicate and gain the trust and cooper-
ation needed to get enough people to agree to take the treatment every six months for years and years. Paramount to success was good and sustained treatment coverage of the entire local population.
To understand how to do this, we were visiting terribly impoverished coffee plantations on the slopes of Guatemalan volcanoes, where the rivers cascading down the slopes created perfect breeding grounds for the black flies and river blindness parasites. It was in these areas that blindness was epidemic and more than 80 percent of villagers were infected. With skilled interviewers, we conducted a “knowledge, attitudes, and practices” survey, hoping to find out what health issues were highest on the villagers’ list of concerns. Of course, a finding that river blindness was a significant concern to the villagers would predict a greater chance of success with our mass treatment approach; if river blindness was not a priority for the villagers, we would have an educational challenge ahead of us. The most important question on the survey: “What do you think are the major health problems in your village?”
Most of the villagers were indigenous peoples; the men spoke Spanish, albeit haltingly, but most of the women spoke only their native Mayan languages. It was a tremendous logistical hurdle to capture the information we sought. We had to design our survey questions well to be sure we posed the kinds of questions that would give us the answers we needed to design the best health educational approach to accompany the mass treatment program.
As the sun was setting one evening, casting an angular orange glow on the small plantation where we were conducting the survey, I sat with the interviewer working with me in a hut with a thatched roof, interviewing a family. I was trying to be inconspicuous, sitting in a corner on an old chair, letting the interviewer do all the work. A mangy dog lay by my side. Kids were running around with almost no clothing, malnourished, with obvious deep skin sores from scabies (another parasitic disease), dodging the chickens that roamed freely around the room nipping at insects on the dirt floor of the hut. This was my seventh or eighth interview on this project, and I was growing accustomed to hearing, in response to our “major health problems” question, diarrhea, worms, pneumonia, and other typical scourges of the developing world. Only a couple of the prior interviewees included river blindness on their priority lists, which made us realize education about the disease would be critical for gaining acceptance of our treatment program.
Sitting in another corner of this tiny hut was an old man. He was tanned, had a white stubble beard, and was dressed in rags like the others. Yet he had subtle nobility about him; he seemed to observe the event distantly. He hadn’t said a word as my interviewer questioned others in the family, but I noticed him staring at me from time to time throughout our visit. Whenever I looked back at him, we briefly met eyes. Glaring is not the right word, since I did not think he was hostile toward me, more curious. Finally, after the others had spoken, I returned his gaze and asked in a soft respectful voice, in Spanish, “Señor, what do you believe is the major health problem here?”
He met my gaze and his reply came after a short pause, “Fijese esta pobreza que no se escapa.” Translation: “Fix yourself on this poverty that cannot be escaped.” Then his face softened and, nodding, he almost seemed to smile at me, as if to say “Here endeth the lesson. Education complete, my son.”
It struck me as a lightning bolt, straight between the eyes. Of course I knew that. Lessons are miraculous when you know them already, when it only takes someone to articulate for you what you know. I was so fixated on this one disease, this one effort, that I was lost. Now I was enlightened, and ashamed and humbled by the obviousness of his statement; how could I be so blind to it? My teacher knew I had asked a shallow, stupid question; it was his concise and profound answer that mattered. Speechless, I averted my gaze, nodded and bowed my head. When the interview was over I shook his hand, met his eyes, thanked him, and left, never to see him again.
His face and his answer still haunt me today, and I can call upon the memory of that experience at will, reliving the full emotions, visions, sensations of that very moment.
We international health experts, well-intentioned and highly motivated, wade deep in our weeds of infectious diseases theory and infection control strategy, studying patterns and trend lines of illnesses and deaths in isolated villages. Yet this wizened man had found a perch above it all from which he could see the big picture and teach us doctors a lesson.
As I have often reflected on this wonderful event, the lines of an Eagles song always come to mind:
“An old man told me
Tryin’ to scold me . . .”
I guess he was softly scolding me, as a good teacher might, to get that tension to pass that message to the obtuse student. Of course river blindness was a major health concern in Guatemala and on this coffee plantation—as were diarrhea, pneumonia, typhoid, malaria, and hepatitis. But the major health problem, above all else, was inescapable poverty. Imagine: poverty so great and powerful, so all-encompassing and ever-present, the root cause of all infection and perhaps all illness. A downward spiral generated a spiritual hopelessness; utter despair for a future that can be no more than that hut, and all that it encompassed. Cure my poverty, and you will cure me.
As I write this essay, I am also completing my report for a medical journal on the successful elimination of river blindness from Guatemala. One hundred years after a Guatemalan was the first to discover river blindness, that nation has requested verification of elimination of the disease from the World Health Organization. The juxtaposition of these two writing projects, the eradication report and this essay on “the real major medical problem,” is powerful. On the one hand, I’m excited to have reached this stage of our river blindness mission, to have achieved the goal we set out to achieve nearly three decades years ago. On the other hand, when seen from the perch of that old man so many years ago, our accomplishments are only a small piece of the dilemma. That old man, if he is living, doesn’t have river blindness to worry about any more. But so what? The job is yet undone; so much more to do. Sweet—yet bitter—success. As a father he warned me of the height of the mountain that I was daring to climb. Keep heart and keep sanity.
“Whoa, son, don’t wade too deep in Bitter Creek.”
How miraculous his single sentence was for me, and how much it taught me! I am a different person and different physician because of my visit to the old man’s hut in 1988.
I encourage my public health students to expose themselves to similar uncomfortable situations, to be attentive and learn from the most humble of those we have the opportunity to meet and interact with in our profession. What we will find will be unexpected insight and wisdom. What they tell us will miraculously reenergize our commitments and renew our strengths. It will plant a seed that will sprout as motivation for the next difficult step in our mission to help leave a better world.
Step back from the statistics and data to find a perch, and try to see the big picture. That old man did just that by scolding me and warning me, all at the same time.
The results of our 1991 survey where I met the old sage can be found at:
F. Richards, R. Klein, C. Gonzales Peralta, R. Zea Flores, G. Zea Flores, and J. Castro Ramírez. Knowledge, attitudes, and perceptions (KAP) of onchocerciasis: A survey among residents in an endemic area in Guatemala targeted for mass chemotherapy with ivermectin. Social Science and Medicine 1991; 32: 1275–1281.
The results of our declaration of river blindness elimination in the Central Endemic Zone:
Frank Richards Jr, Nidia Rizzo, Carlos Enrique Diaz Espinoza, Zoraida Morales Monroy, Carol Guillermina Crovella Valdez, Renata Mendizabal de Cabrera, Oscar de Leon, Guillermo Zea-Flores, Mauricio Sauerbrey, Alba Lucia Morales, Dalila Rios, Thomas R. Unnasch, Hassan K. Hassan, Robert Klein, Mark Eberhard, Ed Cupp, and Alfredo Domínguez. One hundred years after its discovery in Guatemala by Rodolfo Robles, Onchocerca volvulus transmission has been eliminated from the Central Endemic Zone. American Journal of Tropical Medicine and Hygiene 2015 Dec; 93(6): 1295–1304.
For more information on river blindness and our efforts to eradicate this disease: http://www.cartercenter.org/health/river_blindness/index.html
Date of event: 2001
The Miracle in
the Middle
Mark F. Cotton, M Med (Paed), PhD
For a child born almost anywhere in Africa in 2001, and for that matter in many parts of Africa still today, the phrase “medical miracle” is an oxymoron. The cumulative devastations of famine, disease, and dire poverty conspire to make good outcomes a rarity. This is all the more so for children born with AIDS, the rate of which was still growing alarmingly in 2001 before it finally peaked in 2002. That’s what makes this baby’s story so miraculous.
Little “Anna” was born in 2001 to a mother living in one of the poorest “informal settlements” (dense clusters of thrown-together, ramshackle huts and shacks where the destitute live) in South Africa. Early in life she devel-
oped chronic lung disease, a common manifestation of congenital (acquired at birth) AIDS. She was dependent for survival on receiving supplemental oxygen through a tube in her nose attached to an oxygen tank. She could not possibly receive such therapy in her home, a shack without plumbing and electricity. She lived in our hospital for more than three months with no sign that her lungs would ever heal enough to be able to return home. Such is the nature of the AIDS lung disease in babies.
In the hospital, she spent almost every minute of her life lying flat on her back, receiving oxygen. Trying to breathe was her main job—there wasn’t energy left for rolling over, or smiling, or playing with a rattle. There also wasn’t enough energy left to grow, and she was failing to put on weight. We all loved this little baby—the doctors, nurses, and aides. We took her for walks, along with her oxygen, whenever anyone had a free moment. But the hospital was always understaffed, and there were few free moments. So mostly she just lay there, alert, aware of everyone around her, desperate to develop as a baby, but simply too debilitated by her lung disease and her inability to eat.
We now know that using “triple therapy”—three powerful drugs that treat HIV, the virus that causes AIDS—is the most successful approach to treating patients, including young infants. The first clinical trial of triple therapy for children in South Africa began in 1998 and was funded by a pharmaceutical company. Early results looked very promising, and we began trying to raise independent funds to pay for kids’ triple therapy once the clinical trial was over and the pharmaceutical money gone. Thanks to private fundraising efforts led by my wife, Reena, and others, especially HOPE Cape Town, we were able to buy triple therapy for little Anna and a number of other babies that year. The pharmaceutical company gave us a limited grant to buy anti-HIV drugs for the ongoing treatment of the 1998 study patients, of which Anna was not one (she was born in 2001, too late to be included in the study). By a combination of private donations and that grant money, we patched together enough stocks of medicines to treat Anna and the others. But for how long could we continue to afford to treat these babies? We knew that once the money ran out and their therapy ended, their HIV infection would flare, their AIDS would relapse, and they would die.
The results in Anna were nothing short of amazing. True to the impressions we were getting from the 1998 study and from similar research else-where about the benefits of triple therapy, Anna dramatically improved. Her lung disease was cured by the anti-HIV drugs—cured! She no longer needed oxygen, she gained weight, and she caught up on her developmental mile-stones. Assessments of the living situation of her biological mother, who was never able to visit her child in the hospital, were bleak. Anna’s biological father had deserted the family when he heard his wife and daughter had AIDS. Anna’s biological mother found a new partner, but didn’t disclose her HIV infection to him, and was now pregnant again. It was clear that a foster home would be needed to provide adequate medical care for Anna, and we found an excellent placement for her. We didn’t know how, or for how long, we could afford to pay for her triple therapy, which was lifesaving.
We managed to beg, borrow, and stretch our funding for Anna’s and the others’ treatments from 2001 to 2004. Then, just as we were confronting the reality that the grant funding was ending and we had run out of private donations, a miracle arrived from the unlikeliest of sources: the government of South Africa announced it would provide free access to triple therapy for all AIDS patients in public clinics. Because of our experience with anti-AIDS drugs for children, our clinic was one of the first to obtain these life-saving medicines for children, with just days to spare before Anna’s therapy would have ended.
Anna continued to thrive in every way, receiving her triple therapy in her foster home without interruption, never knowing how close we came to failing her. Sandwiched exactly in the middle between the first clinical trial for children in 1998 (three years before Anna was born), and 2004, the year effective therapy finally became available to all babies born with AIDS in South Africa (but three years after she needed to begin treatment), it wouldn’t have seemed as if Anna had much of a chance of survival. Without the anti-HIV medicines, she would have wasted away in the hospital and died of her lung disease.
Instead, thanks to the highly improbable confluence of Good Samaritans’ generosity, a grant from a pharmaceutical company, and the government’s timely policy change, Anna is a survivor of AIDS in Africa.
Miraculous.
For more about HOPE Cape Town: http://www.hopecapetown.com
Date of event: Early 1990s
When the Student Is Ready, the Teacher Appears
David Addiss, MD, MPH
On a granite wall in the lobby of the World Health Organization (WHO) headquarters in Geneva, an aspirational vision is inscribed in several languages: “The attainment by all peoples of the highest possible level of health.” Within this building, and in medical centers, public health agencies, and clinics around the world, an estimated 59 million people in the global health workforce labor to improve the health of all people—including some of the most marginalized and neglected populations on earth. The people who benefit from their dedicated efforts may never know—or even be aware of—the millions of global health workers who serve on their behalf. Yet, over the course of time, the results of those efforts are nothing short of miraculous.
At its best, global health represents a massive effort to alleviate and prevent human suffering, without regard to race, religion, nationality, or creed. Those who work in global health aim to improve the health of entire populations. They deal with numbers, graphs, and statistics. They may work in sprawling government agencies or in small volunteer organizations. What motivates this outpouring of compassionate action? What is it that makes this work so deeply meaningful? What is it that sustains the spirits of these workers in the face of overwhelming challenges of disease, poverty, bureaucratic frustrations, political inaction and, at times, insecurity and conflict?
Often it is a personal encounter with a particular individual that has provided the most powerful inspiration. The stories of these encounters, which may have lasted only moments, can sustain an entire career. The content of these stories varies. Community health workers may remember a neighbor or community member who endured a devastating illness with dignity and courage, or they may have borne witness to the life-saving power of a simple intervention, such as oral rehydration. Physicians may recall particular patients whose lives touched theirs, perhaps with a sense of gratitude in having accompanied and been of service to someone who overcame a serious illness. Some of the most poignant stories are “wake-up calls,” in which assumptions were challenged and the limitations of the health worker’s knowledge or efforts were starkly revealed. My colleague, Frank Richards, beautifully describes such an encounter in another essay in this book (“The Miracle of a Single Sentence”). My story was also a “wake-up call.”
During the early 1990s, I was part of a scientific team at the Centers for Disease Control and Prevention (CDC) studying new drug treatments for lymphatic filariasis (LF), a disfiguring tropical disease caused by parasitic worms that are spread by mosquitoes. In humans, the adult worms live in the lymphatic vessels, channels that drain excess fluid and waste from body tissues. The damage to these vessels caused by the worms results in swelling of the leg, known as lymphedema, in an estimated 14 million people worldwide. As lymphedema progresses to its advanced form, elephantiasis, the skin becomes rough, thick, and hard—elephant-like. These changes in the tissue reduce the movement of the affected limbs and the ability of its victims to work. Episodes of pain, inflammation, and high fever, called acute attacks, occur, further damaging the skin and underlying tissue.
The prevailing hypothesis at the time I began in this work was that those horribly painful and debilitating acute attacks were triggered by the body’s own reaction to the adult worm, that the progression of lymphedema was due to that abnormal immune response, and that nothing could be done to alter the course of the disease. In many communities where LF is prevalent, lymph-
edema is considered a mark of shame, a sign of having been cursed; those who develop lymphedema are to be avoided for fear of contagion. People with LF sometimes consider the social, psychological, and emotional suffering of stigmatization to be worse than the physical suffering it causes.
As I joined the CDC team and began traveling with them to Ste. Croix Hospital in Leogane, Haiti, I was struck by how little we understood about this ancient disease. We began to investigate some of the most perplexing questions about LF by correlating clinical and laboratory findings on individual patients. My role, as the clinician on the team, was to examine patients after my colleagues, laboratory scientists, had tested their blood for the LF parasite. To those who were infected, I gave a standard dose of the recommended medicine, diethylcarbamazine (DEC). A very brief encounter with one of these patients changed the course of my life.
It was a hot, humid August night in the outpatient clinic of Ste. Croix Hospital. Toward the end of the evening, a thin young woman, seventeen years old, approached the airless, stifling examination room where I was working. I greeted her and invited her in, noticing that one of her legs was already swollen and the skin was starting to thicken. I learned through a translator that the swelling had begun two to three years earlier and it was getting progressively worse. I was tired. It had been a long day. In a rather perfunctory way, I took measurements of her leg, did a cursory examination of her heart, lungs, and limbs, and checked the laboratory sheet, which told me that, indeed, she was infected with the LF parasite. According to protocol, I measured out the proper number of DEC tablets for her weight, placed them in her open hand, provided a cup of water, and asked her to swallow the pills. I will never forget what happened next.
Instead of closing her hand around the tablets to swallow them, she looked me straight in the eye with a weary look of exasperation and disgust. Holding her gaze, she raised her hand upward, and with a flourish threw the DEC tablets forcefully, angrily, across the floor of the small room. She turned on her heels and marched out of the room. I never saw her again.
I was stunnned and, for a moment, indignant. Didn’t she know we were offering her the standard treatment, recommended by the experts at the WHO, for LF infection? Did she not recognize the efforts our CDC team had made to travel to Haiti and provide what limited care we could? How dare she waste those tablets when other infected patients could have benefited from them! Didn’t she know her lymphedema could get worse if her infection was not successfully treated? But the fire in her eyes soon made me realize that she understood, at a level that I had not yet accepted, that our drug treatment, the international “standard of care” from the experts who advised WHO, would do nothing to prevent her acute attacks or her leg from swelling further—nor would it reduce the stigma and social isolation that she was already experiencing. She had been offered pills before, with no effect. She knew that for her, and we would later learn for tens of thousands of other patients as well, DEC alone would not meaningfully change her disease. She was unimpressed by these foreigners who had encouraged her to come to the hospital clinic with the promise of hope, but instead only took her blood for tests, made a few measurements, and offered some pills that would be of little or no benefit. We were wasting her time. She knew she needed more than DEC—we just didn’t realize it yet.
An Eastern proverb says that when the student is ready, the teacher appears. This young woman had become my teacher. I could not shake her fierce gaze. She had opened my eyes and forced me to see that our scientific theories, academic publications, and travel to exotic places to do research offered little real hope to her or millions like her. My fundamental assumptions—not just about how LF does what it does, but also about what exactly I thought I was doing—needed serious rethinking.
When the student is ready, the teacher appears. The young Haitian woman prepared me to receive with an open mind the instruction of another teacher. Gerusa Dreyer is a dynamic Brazilian physician whose astute powers of clin-ical observation and compassionate care for thousands of patients led her to a new understanding of LF. She came to question the dominant theory that acute attacks were caused by the body’s own response to the adult worm. To Dr. Dreyer, many of these attacks looked just like common bacterial infections of the tissue known as cellulitis. Her research showed that breaks in the skin and sores on the feet and legs allowed bacteria to enter, and that poor drainage through the diseased lymphatic channels allowed the bacteria to flourish. In other words, the disease caused by the worm predisposed the patient to the bacteria, which in turn caused the acute attacks. That’s why DEC alone could never work in that young Haitian woman. In her own dramatic way, that’s what she was trying to teach me.
If acute attacks were due to bacteria, they might be preventable! Extend-ing her research, Dr. Dreyer showed that progression of lymphedema to elephantiasis could be halted, and in many cases reversed, by a simple regimen of hygiene and skin care (to treat and prevent the breaks in the skin that could allow bacteria to enter), movement, and leg elevation. She organized “Hope Clubs” to teach her patients self-care and to overcome their social and emotional isolation.
I arranged to travel to Recife, Brazil, to visit Dr. Dreyer and to see for myself what she was doing. All too aware that her message of hope went against the grain of what medical scientists thought possible at the time, she insisted on two things before she allowed me to visit. First, I must learn enough Portuguese to converse with and understand the patients as they described their experience. Second, if I was convinced by what I saw, I must promise to do what I could to bring these teachings and practices to Haiti.
A “Hope Club” happened to be scheduled on the day I arrived in Recife. I was astonished by the festive atmosphere and by the palpable sense of empowerment, community, and, yes, hope that pervaded the room. Many of these patients had advanced lymphedema, but they were animated, joyful, engaged. I spent several days in the clinic, learning from Dr. Dreyer’s team, speaking with patients, and learning her simple but profound lymphedema self-care techniques.
I was so deeply moved by this experience that I dedicated the next twelve years of my life to this cause. With Dr. Dreyer’s help, my colleagues in Haiti established a lymphedema management program there, along with Hope Clubs and support groups. Together with others, we did studies to demonstrate the effectiveness of these techniques, participated in lymphedema train-ing for health workers around the world, and pushed for this type of care to be considered an integral part of the WHO program to eliminate LF as a public health problem. No longer would we be handing out DEC tablets alone to treat lymphedema or elephantiasis.
It is possible—indeed likely—that I would have done none of this had I not experienced the defiant gaze of the young woman in Haiti. The power of these individual encounters, and the meaning they convey, are a rich source of inspiration for global health action. Global health is a complex, somewhat chaotic system of international agencies, governments, non-governmental organizations, and foundations, often with competing priorities. So much less would be achieved through these organizations were it not for the networks of trust, respect, and—why not say it?—love that join people together in common purpose. The qualities that motivate global action to relieve suffering are so often inspired and nurtured by the memory of a particular encounter with an individual.
During the past several years, what we used to call “international health” has been replaced by “global health,” which is grounded in the realization of human interconnectedness. The epidemics of HIV/AIDS, SARS (severe acute respiratory syndrome), and Ebola virus—to name only a few—have shown us how deeply interdependent our health and health systems are. In a real sense, the distinction between global and local has virtually disappeared. For example, Chagas’ disease, a parasitic disease spread by bugs that live in thatch roofs and walls, was once limited to Latin America. The debilitating heart failure and premature mortality caused by Chagas’ attracted little attention elsewhere. However, with immigration and global travel, Chagas’ disease is increasingly recognized as a public health problem in the United States and Europe. What was once a local problem now requires a global solution.
The miracle of global health lies in the power of an individual face, an individual encounter, to transform a heart, change a life, and inspire a career that alleviates human suffering on a global scale. Global health is an expression of this rich interplay between the faces and the numbers, individuals and populations, global and local, the whole and its parts. In the busy day-to-day work of global health, immersed in programs, numbers, and bureaucratic challenges, it is easy to lose sight of the faces. In the words of Catholic theo-
logian Gustavo Gutiérrez, we must continually drink from our own wells. The living memories of our individual stories make possible the refreshing waters of renewal and regeneration.
Spiritual teachers through the ages have pointed toward our human interconnectedness and the need to have compassion for all. To paraphrase the words of Mother Teresa, they teach us to draw the circle of our family ever more widely. Thousands of years ago, when humans still lived in small bands of hunter-gatherers, such a universal vision would have seemed incomprehensible, unnecessary, and even dangerous. It is still not an easy vision to practice. However, we now realize that adopting this vision is essential for the future of the planet. Global health is in the vanguard of carrying forward, in practical ways, this universal spiritual vision. It is this vision that is inscribed on the wall at WHO and inspires the 59 million people dedicated to global health care.
The face of the young Haitian woman with lymphedema remains with me still. I do not know what became of her. Did she ever benefit from the lymphedema management programs that were established in Haiti? I don’t know. I do know that, if she has children, they are growing up free from the threat of LF, as are millions more around the world, thanks to the efforts of a vast army of community health workers, government health officials, and non-governmental organizations. And now, hundreds of thousands of people with lymphedema in dozens of LF-endemic countries are learning the self-care techniques that Dr. Dreyer developed and taught.
I am grateful for what the young Haitian woman taught me and grateful for the millions of people from all walks of life whose courage, wisdom, and insight continue to inspire the field of global health.
To learn more about the work of global health, see:
Koplan, J. P., Bond, T. C., Merson, M. H., Reddy, K. S., Rodriguez, M. H., Sewankambo, N. K., & Wasserheit, J. N. (2009). Towards a common definition of global health. Lancet, 373, 1993–1995.
Addiss, D.G. (2013b) Global elimination of lymphatic filariasis: A mass uprising of compassion. PLoS Negl Trop Dis. 7(8): e2264. doi:10.1371/journal.pntd.0002264.
Addiss, D.G. Globalization of compassion: The example of global health. In: Gill S and Cadman D, eds. Why love matters: Values in governance. New York, NY: Peter Lang Publishing 2016; 107–119