Jennifer is not joking!

November 06, 2017

“Thousands of deaths are occur due to Hepatitis A and E, millions are dead because of Typhoid fever, uncountable are suffering by cause of Malaria, Dengue, Chikungunya and Tuberculosis ” Jennifer was sitting infront of me and sharing the facts with regretful feelings. “Any solution, how we can be saved” I asked “There is hope, this seems an arduous battle, but we will be successful”

Jennifer works for mother-and-child health in less-privileged areas of Sindh. Since many days, a meeting was due over the topic of present health scenario of the people who are living in those unfortunate places. Fortunately, in a recent day, I got success finding myself at her work place.

Our discussion was specifically based upon the large number of the people, who are living in widely backward areas of the country and badly suffering through “infection related diseases”. Such illnesses are really becoming a leading cause of death for the marginalized population of the country.

Pakistan is one of several countries, whose 75% of the total population lives in rural areas and 45% lives under the poverty line, which together bear 95% of the burden of infectious diseases. Malaria, Tuberculosis (TB), and Polio are among the top killers of Pakistani youth and adults - Pakistan is ranked fifth out of twenty-two, on the list of high-burden tuberculosis countries.

Researches have witnessed an alarming average of about one million lives claimed yearly by malaria. Worst of all, Pakistan is one of the four remaining countries where polio is still endemic. Malaria and TB are both diseases predominantly found in rural areas. Likewise, the important infectious diseases, which especially hit Pakistan in past years, were ‘gastro’, ‘dengue fever’, ‘Crimean-Congo Haemorrhagic Fever’. Thousands of cases of gastro and dengue fever were reported in various cities of Pakistan. Infections are more common in the far-flung areas of the country; the main reason behind it is the presence of co-infection.

The unfavorable impact of infectious diseases is found to be most severe among the poorest people of the subject areas. People, who live, work or undertake recreational activities in a rural, agricultural or horticultural setting, are potentially exposed to a large number of infectious pathogens that can cause disease. Individually, most of these infections are rare, but the possibility of a rurally-acquired infection should be considered in patients who have been exposed to this setting. All of these infectious diseases present a large death toll and burden on the population. This situation is also significantly crippling economic growth and investments. Higher mortality rates mean more deaths, less workers, and a weaker economy. These diseases are among the biggest disablers. It is also believed that the economic recession has affected health and society. According to a recent study, rural families with individuals suffering from malaria lose more than 40% of crop yields as a consequence. If left unchecked these diseases could spread across the land and literally wipe out a large percentage of the Pakistani population.

TB rates in Pakistan are in large part due to the widespread malnutrition and access to unhygienic foods. Malnutrition is mostly prevalent in the rural and poverty-stricken regions of Pakistan. It follows that those living in rural areas as well as those displaced by the flood suffer the greatest risk of catching TB. Around 32% of general practitioners in Pakistan fail to administer the proper medication.

As far as malaria is concern, an estimated 12% of the rural population is believed to carry malaria parasites in their blood without showing any physical sign or symptoms. Malaria could be avoidable and controllable at low cost if we could just start investing more in local health development programs. There is utmost need to provide insecticidal nets, which are known for being extremely efficient in stopping the spread of malaria. Building programs to create proper shelter as a result of the flood may also want to be considered. Making sure proper vaccination is available to all would be the final goal in the fight against malaria. Poor people will be most at risk of malaria if they have not been immunized and they live in areas with unhygienic sanitation. The millions of Pakistani people displaced by recent sporadic floods have become the primary victims. Pakistani’s who cannot get proper immunization, shelter, and hygiene are likely to contract the disease. Floods are also a factor as they have left behind many water ponds, which are ideal breeding sites for Anopheles mosquitoes, common carriers of malaria.

Similarly, polio virus is the most dangerous and contagious of the three and typically spreads from person to person through fecal-oral transmission. Polio is extremely contagious and anyone who has not been immunized and is in proximity of a patient is at risk. Any sort of fecal to oral or oral-to-oral contact will result in infection. Polio actually has no cure but a vaccine does exist. There is need to work diligently to assure that the entirety of the population has access to proper immunization. It is important to spread knowledge and information on the importance of immunization. This will not be enough and as such, there is also, a need to train specialize health care units as well as create new health care facilities as close as possible to more inaccessible rural areas. So long as even one child remains infected with polio, children from all other countries will always be at risk of contracting the disease.

Due to lack of access to proper medical facilities, unhygienic lifestyle, lack in productivity, missed educational opportunities and health care of high costs caused by infectious diseases directly affect families and communities. These people have the fewest resources towards integrated health care, prevention tools and medications. Many people living in a rural community do not have access to a reticulated water supply, and collect and store their own water for household use. A rural lifestyle also often involves raising, growing and gathering food, e.g. raw milk, home-butchered or recreationally-caught meat and seafood. These practices are all associated with an increased risk of infectious diseases.

Though Pakistan put efforts to develop primary healthcare across the country, a lot is yet to be done. Besides that, the change in climate, which continued to endanger health and food safety were among the foremost health issues that needs to be focused. According to the experts, Pakistan needs to invest a lot on research on most valuable measures in order to protect health from climate change, particularly in vulnerable populations such as women, children and elderly in the country. It will really be an essential step to focus on the areas where poverty has handicapped people the most. This includes the areas where basic facilities necessary for hygienic living condition have been destroyed like sewage systems, clean water, and basic healthcare facilities. Trauma centers need to be developed in all major cities of the country, however; almost no attention has yet been paid to the subject. Social inequities and injustice still kills people on a grand scale.

We must increase productions of health facilities and begin training general practitioners properly. Proper care and immunization will be crucial in dealing with polio, malaria, and TB. The issue of infection-based diseases can be resolved by creating and funding education programs and properly trained care units. This will allow heath care staff to properly treat infectious patients as well as increase the quality of care general practitioners are providing the population with. This will be efficient because over 80% of Pakistani patients who suffer from infectious diseases first go to a private practitioner for diagnoses.

On these notes, discussion finally got an end but I was really thinking of those efforts that need to be done to make us “successful”, as Jennifer hopes.