January 21, 2017 1:11:47 am
As I reflect on my years in public health, among the first things that come to mind are my experiences in India. The US Centers for Disease Control and Prevention (CDC) works with more than 60 countries worldwide — but our relationship with India will always have a special place for me.
My first experiences in India, as a medical officer for the World Health Organization (WHO) on loan from CDC, were among the most rewarding and challenging years of my career. We built a programme that dramatically improved the diagnosis, treatment and monitoring of tuberculosis (TB) by supporting Indian physicians, state, municipal and district governments, tuberculosis control staff, community organisations and, most importantly, patients. I learned so much travelling the roads of India alongside my Indian colleagues — I had the privilege of travelling to more than 30 states and union territories, more than 200 districts and more than 1,000 towns and villages to listen to healthcare workers and patients. What I learned guided me as New York City Health Commissioner and CDC director; it will continue to inform and inspire me on the road ahead.
Our collaborations have grown over the years. These include global health security, improving HIV prevention, eradicating polio, better prevention of non-communicable diseases including heart attacks, strokes and cancer, working to eliminate measles and assisting India for organising a Kumbh Mela. CDC and India’s ministry of health and family welfare (MoHFW) together established an immunisation surveillance network covering all states, launched the first Indian Epidemic Intelligence Service training programme, strengthened tracking of healthcare-associated infections and lab diagnosis and intensified tracking fever and encephalitis syndrome across 15 states. These programs save lives.
Recently, CDC and the Indian government collaborated in a comprehensive outbreak investigation that identified a naturally occurring fruit toxin in litchi as the source of acute encephalopathy in children in Muzaffarpur, Bihar. The previously unexplained illness was caused by a toxin in litchi fruit causing low blood sugar, particularly in children who had not eaten dinner. Working closely with the MoHFW, we reduced the outbreak’s toll through several measures, including a public education campaign in Muzaffarpur to encourage families to ensure that children regularly ate an evening meal, and making recommendations for healthcare professionals to initiate rapid glucose correction for suspected illness. (Litchis are safe to eat, by the way — I recall many happy hours devouring litchis, one of my favorite fruits, in Bihar; however, children from the affected areas should minimise eating litchis and be sure to eat a meal at night).
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The combined efforts between CDC and the MoHFW on broader issues are significant as well — none more than our partnership on the Global Health Security Agenda (GHSA). The importance of the GHSA cannot be understated in today’s interconnected world, where any disease can travel from its source to any other spot on the globe in just a few hours. That’s why India’s embrace of the GHSA in 2014, as one of the initiative’s 17 original partners, is admirable. In the past year, public health officials in India successfully managed more than 35 disease outbreaks in all corners of the country — more than 2,000 people received training to strengthen and expand India’s ability to detect disease early and respond quickly and with certainty; laboratories have been strengthened and can rapidly diagnose more pathogens than ever before.
There is much more to do. We must better detect and respond to known and unidentified pathogens across every district. Hypertension continues to contribute to increased illness and death. According to the WHO, more than 20 crore people in India have uncontrolled high blood pressure. Simple, low-cost, generic medications could prevent heart attacks, strokes and other complications.
The key triad in public health is political will, technical rigour and managerial excellence. Whether the problem is tuberculosis, drug-resistant and emerging infections or high blood pressure, getting these three areas right can save millions of lives.
As for me, no matter where the public health road leads now, I will always be better for having travelled roads throughout India.
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