Prior to this class, I could rattle off the names of infectious diseases and plagues, but I could not tell you much else. I could have told you how HIV was spread and the conditions that made cholera so prominent, but in my mind, and in my past learning, diseases such as these were studied in the context of isolated regions or periods. This class has opened up my eyes to the study of infectious diseases, and the realization that they are so much more than anything I had learned before.

Although I do my best to keep up with humanitarian crisis as an International studies major, not much of our class discussion is devoted to global health issues. While we talk about refugee crisis and camps that line borders in regions of conflict, we seldom consider the conditions as precursors to an epidemic. While we talk about the way women’s roles have changed an improved, we do not site their leading role in combating disease spread as found in India with the campaign against cholera. While we talk about the growing presence and strategic use of technology, we do not study its projected use in the case of health education. For something that touches so many lives, so deeply, it is astonishing how easy it is to overlook and avoid conversation regarding it.

While the sections on the plague were the most informative and frightening, the cholera and HIV sections were my favorite. The cholera chapter was fascinating because of the public education that was taking place in teaching areas how to avoid contraction of the disease. These are easy practices to put in place, and ones I was very motivated to support across the world in whatever way I can. The HIV section was also incredibly interesting because it is one of the more popular diseases, in that you hear a lot about it socially. To now have studied the scientific side of the disease, I can piece together all the other bits of knowledge I had on it previously and better understand the illness. I also really enjoyed the documentary that articulated how different countries handled/addressed the HIV crisis. It was fascinating to see the way different morals and cultures produced a variation of responses from the health sector on working to cure the disease. It shows that there is a lot countries can do to learn from each other and emphasizes the importance of international communication.

Perhaps is it true that I left class, on more occasions than not, a bit more paranoid than when I entered. This is because my eyes were opened to the easy in which diseases can spread, and with a growing number of drug resistant strands, the dangerous amount of time it historically took doctors to find a treatment, or in some cases a cure. The learning of this semester has made me a more conscious member of society, eager to uphold clean personal practices, and a more motivated advocate for the health sector. As I aspire to one day work for the government, I am glad to have had the learning of this class as it has ingrained in me a greater appreciation for the health sector where I support the ample donation and allotment of funds. Such funds will help for the quick reaction when diseases begin to spread, but also hopefully create greater preemptive measures and practices that can protect the population from such terrible outbreaks from occurring again.

Thank you for a great class this semester!

Cholera is a water or food borne disease that is most notably spread through the oral-fecal route from contaminated water and food. It attacks the lower intestine and causes an extreme loss of water and salts. Cholera originated in India around the 16^th century and has since had seven pandemics across the world. Colonists and merchants carried the illness across the seas to infect new countries and populations. Particularly after it was brought to America through the Irish immigrants, the disease came to be associated with the poor community. The spread rapidly increased, especially in London, with the urbanization that less living space and no proper sanitation.[1]

The waves of infection only diminished by the implementation of new sanitation and hygiene practices, and the work of researchers like John Snow, who studied the disease in depth to understand how it arises. He proposed the contagion model, rather than the miasma model, as an explanation for contraction. He was also instrumental in identifying contaminated public water as being a key factor in the spread of the disease. Others added to the conversation, like William Farr, who proposed the contingent contagionism model.[2]

In Haiti, the cholera crisis continues, particularly because the lack of proper sewage systems. Rather than have a stable and regular plumbing system, workers enter the streets each night to carry human waste by hand. Even then, the problem is not resolved as the waste is not taken to a sewage plant, but rather put back into the streets, into the water, anywhere it can be causally dispersed. With each rain storm or regular rain, the waste moves back into the streets and in human contact so facilitate the spread of Cholera.[3]

This is also an issue in Yemen and Mozambique. As humanitarian crisis rage through these places, there is not proper sanitation practices in place and the population is left vulnerable to the illness. In Mozambique, the lack of clean drinking water, hygiene, and the presences of hundreds of decomposing bodies makes the spread of cholera and other diseases much more serious.[4] In Yemen, the same situations are arising, and the cancellation of vaccine shipments and aid deliveries[5] sends the message that there is a solution, its just not being implemented to the necessary degree.

[1] Powerpoint

[2] Powerpoint

[3] https://www.npr.org/2017/07/30/540359412/haiti-s-bayakou-hauling-away-human-excrement-by-hand

[4] https://www.aljazeera.com/news/2019/03/mozambique-cholera-malaria-cases-reported-cyclone-hit-beira-190323060006297.html?utm_source=STAT+Newsletters&utm_campaign=ccc1e82acf-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-ccc1e82acf-149731405

[5] “Vaccines blocked as deadly cholera raged across Yemen”

Tuberculosis is an infection caused by a bacterium and mainly targets the lungs, kidneys, bones, lymph nodes, and brain. It is commonly spread through sneezing or coughing, but other forms/strands of TB are spread by blood and not contained strictly within the immune system. These are called military and resemble more seed like pockets than the cavities TB usually creates in the lungs. Tuberculosis in the bones, commonly called Pott’s disease, eats away at the spine for example, making the bones incredibly thin and fragile, but also warped. The disease can also infect the urinary tract and body parts like fingers and the skin.

Finding strands of TB from ancient Egypt, the disease is known to have spread in waves throughout the world bringing an extreme death toll. Moving through America, it brought fears of dancing, spitting, and kissing, all which were thought to spread tuberculosis. Crowding, dirty streets, and living conditions of the impoverished were all see as factors that made contraction of TB more likely. For that reason, the streets were disinfected, women shortened their dresses so not to drag on the streets, and fresh air was used as a treatment for the inflicted, breaking them from the busy population and placing them in isolation. Now, there is less mass fear surrounding accidental contraction of the disease, but rather greater methods of treatment. For example, there are currently 10 drugs approved by the FDA to treat TB. There is a heavy emphasis on proper and full treatment in that the inflicted take the prescribed medication, or combination of medication, for the fully prescribed period. Failure to do this can lead to more drug resistant strands of the disease to form. Medical researchers are also concerned with targeting low income populations and those infected with HIV to better control the disease and possible new strands that could form from their contraction and lack of treatment. The Lancet Commission states that this effort of appealing to this social community, as well as the universal efforts to treat and diagnose the disease will aid in the effort to end tuberculosis all together. Only if the powerful parties contribute considerable aid and attention to researching the disease will the People’s Plague be ended once and for all.

Help Received: Class Powerpoint, provided articles and reading

The Irish potato famine began in Ireland around 1845 and crippled the country’s crops. Potatoes were a staple to the Irish meals and tradition, as it was high yield crop with little labor necessity. When the blight struck the primary crop then, the population suffered dramatically as they lost close to a half of their most critical food product. This led to millions of deaths and mass starvation, disease, and emigration around the 1850s. It also led to a mass migration movement of Irish citizens to seek better living conditions in the United States.

The fact that only two primary variations of the potato crop were used made the famine more likely to occur. Oomycete was the fungus identified to have spread throughout the plantations, making the potatoes small, mushy, and inedible. This HERB-1 strand was thought to come originally from Mexico, and have traveled through North America before contaminating a ship that spread it across the world, particularly Ireland. With the undernourished population, people became more susceptible to contracting disease such as measles, TB, and whooping cough. Poor hygiene lead to diarrheal disease to also spread and even Cholera was spreading throughout Ireland. The Irish were suffering on several fronts. The Irish carried these with them as they fled the country, leaving one disaster, and creating another (mass infection).

To consider if something like this could happen again opens the discussion of plant gene modification. With use of CRISPR, gene ‘editing’, and full on modification, ethical issues and cost benefit analysis are discussed in depth. Conducting research on plant modification would have significant benefits in that it would produce a greater yield of crops, make their growth more controlled and less susceptible to natural disaster, and overall provide necessary and significant food security for our global future. The downside to this, however, is the concern that such new technology could be used as a biological weapon, since such could be spread by insects that are incredibly hard to regulate and control. Many people fear that, should we continue to advance and fully support such agricultural modification, it  would sent a dangerous precedent for other gene manipulation, perhaps in the context of animals and human embryos.

Prior to this class, the only thing I knew about Tuskegee was the role of their airmen in WW2. After the documentary on the syphilis experiment that took place there, however, I was not only applaud that such actions occurred, but that I had never heard of the horrific incident before.

The Tuskegee study sheds light on the ethical issues that arise in the treatment of diseases. In this case, issues arose between the desire to understand the disease and the extent of its infection, and the actual treatment of inflicted patients. It was clearly unethical to allow this population to continue to live with the disease even though they thought they were being treated. Attempts to rationalize it, however, come from viewing that the lose of lives in this study are minuscule compared to the number of people that would be saved from the disease after scientists had a better understanding of how it evolves long term. There were several other issues with the study in that the patients were not aware they were subjects of an extensive research experiment, one that targeted and was bias towards a particular racial group.  Unaware that they were still carrying the disease, they were not properly quarantined and poses a serious threat to the rest of the population they could have also infected.

The bias in this experiment had a significant impact on regional and racial aspects of disease treatment. Since the poverty rate was lower in this county than in other counties, and the participants were all African American, both of these became stigmatized as qualifications for contracting the disease. These continue today, but it has altered slightly to be perceived as primarily drug users. The CDC reports that the most concerning population for those who contract and spread disease are frequent drug users. Although syphilis was not originally spread sexual, it is now commonly spread as an STD and through shared needles. For this reason, the disease plagues lower income areas that have considerable drug issues. The betrayal of doctors in this test lead to a distrust of medical professionals, particularly from this population. Perhaps not exclusively from this social group, such distrust does still occur and threatens the overall health of the population when things such as herd immunity are not practiced or in place.