The tyranny of old and emerging infectious diseases: Implications for the practice of palliative care

Categories: Care.

On the panel were eminent persons including Dr Aaron Motsoaledi the Minister of Health of South Africa, Professor Dame Sally Davies from UK, Dr Hamad Eid Al-Romaihi from Qatar Dr Lars-Erik Holm from Sweden, Professor Gabriel Leung from the University of Hong Kong and Dr Elias Zeurhouni of Sanofi. This plenary panel was part of the summit that attracted over 1000 delegates from over 80 countries ranging from medical practitioners, educators, politicians, innovators, students, royalty, researchers and health managers from diverse backgrounds.

The discussion kicked off with a presentation by Professor Dame Sally Davies who highlighted the major infectious diseases with high mortality. These included HIV, Ebola, TB, Malaria, Polio, Bacterial meningitis and measles. She expressed concern that globally, resources are being taken away from infectious diseases to focus on non-communicable diseases.

In the discussion it was evident that previous medical advancement which produced antibiotics and vaccines to tackle infectious diseases was being eroded by misuse and emerging antimicrobial resistance, poor coverage of vaccines especially in LMICS and the misguided belief by some in developed countries that these diseases are a problem of the developing world. The emerging refusal by some parents in developed countries to have their children immunised because of the alleged link between vaccines and autism does not help issues.

It was mentioned that 18 of the infectious diseases that have emerged in the recent past are linked to animal sources or hosts both domestic and wild. Such infections include the MERS virus, Ebola, bird flu and many others.  All panellists supported the idea of seeing human health as linked to animal health for both domestic and wild animals and all health systems across the globe should work on a united human and animal health system to stem the tide of infectious diseases.

The view of the ministries of health as cost centres and ministries of agriculture as revenue centres should be properly balanced by ministers of finance in countries to ensure appropriate funding and prevent further escalation of infectious diseases.

Dr Motsoaledi called for a single global health care system approach rather than fragmented efforts because these infections such as Ebola, TB, HIV, Malaria and others have demonstrated that they respect no borders. It is therefore wrong to perceive them and handle them as just third world diseases.

Antimicrobial resistance arising out of inappropriate prescription and wanton use of antibiotics by medical practitioners and demand for them by patients is increasing the risks because many of the medicines are rendered ineffective. It was also mentioned that the routine use of antibiotics in poultry keeping and other animal husbandry is contributing to antimicrobial resistance causing untold compromise in the efficacy and effectiveness of these medicines.

Whereas Africa has some countries where access to these medications is not properly regulated and over the counter purchases very common, some medical practitioners go ahead and prescribe them because of patient demand. For doctors not to lose their clients, they give in to pressure and prescribe them on demand.

The emergence of multidrug resistant TB with no new TB medications being developed is also creating a big challenge which the South African Ministers of Health Dr Motsoaledi expressed. He called for more investment into tackling TB as it still poses a major threat to global health.

Professor Leung mentioned the steps that China has taken to stop the spread of bird flu which include the stopping of selling of live poultry in wet markets. Such measures introduced to deal with these diseases should be sustained across the globe and poor countries should not be left to their fate otherwise they will remain pockets of disease with potential to re-ignite global infection.

It was also mentioned the poor health systems in many countries is hindering improvement in vaccines coverage. Dr Motsoaledi gave the example that despite the presence of anti TB medicines for the last half a century, TB is still a major disease with over 80% of all AIDS deaths in Africa caused by TB.

In many places across the globe emergence of multidrug TB means certain deaths as the medicines are either not available or too costly to afford.

The South African Minister further mentioned that practices such as the washing of hands that are known to reduce diarrhoea by over 50% should not be ignored while Professor Davies emphasized that it has been noted that men are not as enthusiastic on washing hands as women. She called on the ministers of health to support steps to be taken at the next World Health Assembly to deal with antimicrobial resistance.

The practitioners of palliative medicine should be interested in this debate. They ignore infectious diseases to their peril because these are a major cause of suffering and pain among the dying and yet carry a risk not only for patients but also health workers.

As efforts are made to establish national and global surveillance systems for infectious diseases; as preventive and treatment strategies are implemented, providers of palliative care ought to consider the integration of infectious diseases prevention and management in palliative care education and practice. This calls for innovation and short of this is to abandon patients with multidrug resistant TB, Ebola and other emerging and old infectious diseases to die painful and lonely deaths. 

*This article was originally published on the Africa ehospice edition


Leave a Reply

Your email address will not be published. Required fields are marked *