Tackling the stigma of ill health through education

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What’s the best way to ignite change in medicine? It’s a complex question with complex answers, but forgive my somewhat trite and very Zen phrasing when I say “change comes from within”. I believe there are few better places to bring about change in medicine than within the hospital/medical setting itself. Peeking into the profession from the outside proves to be difficult; it’s hard to challenge the experience of doctors, nurses, health professionals and patients. But what if we target physicians, patients and most importantly medical students in ways that change the way they see their profession? Rather than continuing with rigid ways of studying, what if we teach through sharing knowledge and resources more widely? 

Untapped resources in the university setting

Let’s step back and take a look at our universities. In a single institution, there are massive amounts of resources. Every discipline is there for the asking, experts in practically every field, peer-reviewed literature at the tips of fingers, and then there are the students – hundreds of thousands of students who are revving to delve into their fields and use what they’ve been learning. 

Doesn’t this look like a hotbed for social change?

Educational facilities— check. Manpower— check. Resources and interest—check and check.

Yet what a majority of college and medical school social change clubs tend to do is simply link to external organisations and volunteer or fundraise. This is not to minimise the importance of these clubs; the experiences that the students collect are no doubt invaluable. But it seems like a key link seems to be missing. Academics. Merging academia with social responsibility is a synergistic relationship that has scarcely been explored.

There have been pilots of this sort of work. Just recently there was an article on a collaboration between the New York Academy of Art and the city’s medical examiner’s office to give faces to unknown individuals who met brutal deaths and whose skeletal remains were found on the streets of New York. In 2013, UCSF medical students were highlighted for editing Wikipedia pages for medical school credit. But we shouldn’t stop there. There is an opportunity to tackle an issue that has been hotly debated and is difficult to conquer. The issue of stigma in health.

Social stigma is the hidden burden of many, if not all, illnesses and can lead to limited access to health services and shame patients into avoiding treatment of curable disorders. The repercussions are huge. Take mental health, for example. An estimated 3.8 million people in the United States live with untreated mental illness in any given year. This includes around 40% of people with untreated bipolar disorder and 51% for untreated schizophrenia. And the consequences of this are, of course, extreme. According to the National Institute of Mental Health, 13,000 suicides are committed each year by adults in the US with untreated schizophrenic, manic or depressive symptoms.

There is serious power in using education to reduce the effects of stigma. A study conducted in 2003 analysed the efficacy of intervention with young people aimed at increasing mental health literacy and found positive attitude scores rose significantly after a short educational workshop.

More accessible information

Educating the public on the underpinnings of mental illnesses can have a tremendous effect and can reduce many preventable tragedies that the world faces today. And medical students are the perfect people to do it. Students serve as the ideal link between the “lay-man” and the world of pure academia as they themselves are amidst the transition. What if they translated that hard-to-understand peer-reviewed literature to make it more accessible? Not only does this benefit the students by assuring that they understand the content thoroughly (if you can’t explain it simply, you don’t know it well enough”, right?), it also gives medical professors the opportunity to clarify evidently hard-to-understand topics. Doctors within the institution can share these articles with patients, and before you know it the entire hospital is involved in a multi-faceted way.

That’s the basis for The Humanology Project, an organisation I founded based at Stony Brook University. Students translate peer reviewed literature into readable blog posts with professors doing the fact checking. The process has been illuminating, fulfilling not only for the readers but for the students themselves. With my eye to the future, I hope to integrate the organisation more seamlessly with Stony Brook Medical Center and eventually begin to collaborate with other university hospitals. Communicating the specificities of science can have a tremendous effect on the way we view and interact with patients. The potential to bring about social change is trapped inside our educational institutions. It’s up to us to unlock it.

*Neha Kinariwalla [2014] is doing an MPhil in Modern Society and Global Transformations. Image courtesy of ddpavumba at FreeDigitalPhotos.net.

 

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On faith and secularism

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I recently accepted an invitation to visit a church in Kalinga Linga, one of the many shantytowns in Lusaka, known locally as compounds. The service was held in a dilapidated classroom where the floor was worn out and had big ruts, the furniture was small, old and not very comfortable and there was an uninspiring zinc roof with some bright florescent tubes attached to it. There were no musical instruments or equipment, but there was plenty of music from the human voice and an African choir can transform the voice like no other. The choice master conducted the range of male and female voices methodically, showing skill, depth and a superb understanding of harmony. The singers sung with a passion for God you can only find on this continent.

Zambia is a very religious country and in 1991 President Chiluba declared that the country was a Christian nation. Gay rights became a political football which rival political parties play to try and discredit each other in the eyes of the most important institution after the state, the Church.

People in Kalinga Linga face many hardships and being able to eat two meals a day is a luxury for many families, yet their faith is deep and unwavering. I have often wondered how those in precarious circumstances maintain their faith, but perhaps the answer lies in the deacon’s opening statement. He said: “Let us thank God that we are alive and energetic.” How strange that those struggling with survival should appreciate and honour the gift of life which those living in comfort take for granted so easily, as they yearn for what they do not have.

Thankfulness

The deacon said that January is the month of thankfulness and I thought how hollow this might sound to a cynic reading about the terrible events in France. Secularism is the privilege of the comfortable while those languishing in the compounds or the banlieux cling to their faith for in faith there is hope and with no faith there is hopelessness.

In the compounds people identify with Jesus because he was poor, he suffered and he was redeemed. Perhaps they need to believe that there is more than this life and the harsh hand it has dealt them. Of course, many well off people are religious. Wealth does not insulate us from illness, accidents, crimes, loss and other vagaries of life or existential crisis. Likewise, there are poor people who have given up waiting for a God who does not heed their prayers. Life is too complex to conform to simple bivariate explanations.

Yet the multitude of faithful poor, downtrodden people in the world is still astounding. In Africa they look to Jesus or Mohamed to find the courage to face another day hustling in the markets, begging in the streets or doing what it takes to put food in mouths. In religion there is community and in community there is help when the load becomes unbearable. There is the discipline of the choir and the literacy of religious studies. And when confronted with the humiliations of poverty the churchgoers in the compound can reclaim some of their dignity.

Perhaps the poor do have more to gain from faith then the middle classes, and religion for all its good and bad will not give way to secularism in Africa.

*Zenobia Ismail [2013] is doing a PhD in Politics and International Studies. Picture credit: ‘Hands’ by africa and http://www.freedigitalphotos.net. 

New hope in the fight against antibiotic resistance

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Imagine yourself cooking a meal or eating out at a restaurant. The next morning you wake up with a minor infection. Your stomach hurts and you can’t leave the bathroom, so you call off work. The illness doesn’t clear in 24 hours, so you go to the hospital. The doctor runs some tests and tells you have a bacterial infection. He writes you a script for some antibiotics and you go on your way. After taking the full course (always take the full course!), you’re back in the hospital with a more severe version of the initial illness. Turns out, the bad bacterium is antibiotic-resistant.

Antibiotics are ubiquitous. Everything from food to toothpaste to hand soap contains some form of antimicrobial compound. Advertisers promise us that these products will keep us bacteria free and safe from getting sick while the science says this is ineffective and naïve at best. Livestock remains the world’s largest consumer of antibiotics, even though recent studies suggest there is no added growth or health benefit when supplementing animal feed with antibiotics. Unfortunately for us, this culture of unlimited and inappropriate usage has led to the rise of antibiotic-resistant bacteria. The pipeline for new antibiotics has virtually dried up and effective alternative treatments using peptides or bacteriophage are proving difficult to bring into the clinic.

Just this past year, the World Health Organisation warned that the 21st century could be the beginning of a post-antibiotic era. Many early antibiotics are already useless and our most powerful antibiotics are growing more ineffective every day. What does this mean for us? Invasive and replacement surgeries would be difficult, if not impossible. Hospital visits would become longer and more deadly. Treatment would become more invasive and riskier.

The loss of antibiotics as a viable treatment option is one of the greatest challenges we will face in the 21st century. Possibly even the greatest. Why? A post-antibiotic era has the potential to send us back over 100 years into medical history where people young and old died of common bacterial infections, such as cholera or pneumonia. The bacterium that causes tuberculosis is continuing to develop resistance to our last-defence drugs and infections caused by methicillin-resistant Staphylococcus aureus, also known as MRSA, are common. Our healthcare systems are constantly being taxed by the challenges posed by these multidrug-resistant bacteria.

Texiobactin

But there is hope on the horizon. A paper recently published in Nature suggests that we are not without natural sources of antibiotics, even entirely new families of antibiotics. The publication’s authors revived an old pipeline, mining soil bacteria for antibiotics, using a powerful new tool that allows researchers to study previously unknown bacteria. This new antibiotic, texiobactin, is effective against Gram-positive bacteria (a group that includes the bacteria behind strep throat, scarlet fever, and tuberculosis) in laboratory studies on mice, significantly more effective than the similar acting antibiotic vancomycin. Texiobactin has a long road ahead before it will be approved for clinical use, but early results are encouraging. Most promising, the mechanism behind texiobactin means resistance will be very slow to develop. The compound attacks cell wall precursors that are highly conserved across all bacteria, so a radical change to these precursors or an enzyme able to modify texiobactin would need to develop before a bacterium could become resistant.

Even after more than a century of bacteriology, we are only able to culture about 1% of bacteria in a lab. The other 99% is an unknown frontier, as unknown to us as the far reaches of space. What promise do these bacteria hold? What benefits will we find in the unseen world? It will take a dedicated global effort to find the next major leap in bacterial treatment.

Antibiotics are not the final answer, but they are a useful tool. Increased funding for fundamental researchers who investigate life’s nuances and for those who are cleverly meeting the challenge of antibiotic-resistance is sorely needed. In addition, better public education on proper antibiotic usage, particularly from health ministries to doctor to patient, new regulations on antibiotic use and a more encouraging (even global) regulatory scheme for antibiotics and alternative treatments are all steps we will need to take if we wish to delay a post-antibiotic era. That era will come, but it is better it does when we have an alternative than when we aren’t prepared.

*Paul Bergen [2013] is doing a PhD in Pathology. Picture credit of the antibiotic cefalexin: Wiki Commons and Sage Ross.