Doctoring in Refugee Camps

Ashis BrahmaUniversity of Texas Health Science Center San AntonioOctober 28th

How to become a tropical medical doctor ? What are health care problems in a refugee

camp ? What are diseases in a Ugandan hospital ? Can you come to Uganda? Q/A

Physician – The Netherlands MSc and Diploma in Tropical Medicine and

International Health in London Field experience Asia (India, Nepal), Europe (UK,

Netherlands), Africa (Burundi, Sudan, Uganda, Ethiopia, Chad), America’s (USA, Colombia)

Gastrointestinal disease

Respiratory tract infections

Skin disease Influenza Eye disease

Risk for outbreaks Meningitis Cholera Hepatitis ‘Malnutrition’

Schistosomiasis Visceral leishmaniasis Typhoid fever Tropical splenomegaly

Praziquantel Stibogluconate Antibiotics Anti malarials

Public Health and Prevention Strategies Education: Teaching people who live in endemic areas how to avoid contact with fresh water containing

snails allows them to make choices that will help prevent infections. This is particularly important for those who frequently come into contact with water, such as women fetching water for household use, fishermen, or children who play in water. It is also important that there be a safe source of water available; education about transmission can’t do much good unless people have the means to put it into practice.

Molluscides: These chemicals are used to kill snails. The human health and ecosystem consequences of applying these poisons needs to be taken into consideration before they are used.

Biologic control of snails: Snail pathogens and snail predators may be introduced to reduce snail populations. It is important to consider the consequences to the ecosystem of the introduction of a new species.

Environmental modification to reduce snail habitat: Water projects can be designed to minimize or eliminate snail habitat.

Sanitation practices: Providing clean water for cooking, drinking, and bathing gives people an alternative to making contact with water that harbors cercariae. Providing modern sewage systems gives an alternative to urinating in places where eggs can be released to fresh water containing snails.

A topical drug: Niclosamide 1% lotion on skin before going in water reduces the chance of infection.

Vaccination: There is currently no vaccine available to prevent S. haematobium infection. Animal trials have been carried out with mixed results.

Changes in skin pigment Coma (late stage) Decreased muscle mass Diarrhea Failure to gain weight and grow Fatigue Hair changes (change in color or texture) Increased and more severe infections

due to damaged immune system Irritability Large belly that sticks out (protrudes) Lethargy or apathy Loss of muscle mass Rash (dermatitis) Shock (late stage) Swelling (edema)

F 70 / F 100 therapeutic milk Amoxycillin FeSO4 + Folic acid Multi vitamins Very frequent feedings Daily weighing Coaching of mother De worming

Benjamin Ajak – They poured fire on us from the skies

John Prendergast & Don Cheadle – Not on our watch

Gray-Garcia & Brahma - Utmost Paul Farmer - Pathologies of Power: Health,

Human Rights, and the New War on the Poor

www.ashis.org www.pghf.org Ashisbrahma on skype, twitter, facebook,

seismic, youtube Gray-Garcia and Brahma ‘Utmost’ http://www.wheatmark.com [email protected]