Local CEO details global health care imbalances

by Lizzie Wise | 5/22/02 5:00am

Faced with the daunting task of presenting disturbing statistics about global health epidemics, Dr. Nils Daulaire engaged a room full of potential public health practitioners, pre-med students and those interested in international affairs in Rockefeller Center yesterday.

Daulaire, who is the president and CEO of the Global Health Council -- its headquarters located only two miles away in White River Junction, Vt. -- elucidated the essential connection between public health care and politics in his lecture entitled "The State of Global Health: Challenges and Opportunities for the 21st Century."

"It's coming on, boys, it's coming on strong," Daulaire said, quoting the film "A Perfect Storm" to convey the enormous power that globalization holds.

Since he first immersed himself in a developing country 25 years ago, practicing in a clinic in Bangladesh as a medical student, Daulaire has worked to reduce inequity in global health care.

"The physician's true charge is not to minimize death; rather, it is to maximize life," Daulaire told the audience, before beginning a slide show replete with overwhelming statistics concerning disease and mortality rates.

Today 56 million people die a year; one-third of these global deaths and are premature and preventable, Daulaire told the students. Infectious and reproductive diseases account for over half of those premature deaths.

Contrary to what people may think, pneumonia is the single leading cause of disease around the world. Daulaire estimated that AIDS, the second leading contributor to the global burden of disease, will probably overtake pneumonia in the next two to three years. Both of these diseases are increasingly affecting children.

"You see some pretty striking things when you look at inequity among children," Daulaire said.

While living in Western Nepal, Daulaire treated a young girl named Laxmi who was extremely emaciated, lethargic and short of breath.

"She merited immediate admission to the pediatric intensive care unit," Daulaire said. However, the closest option to a hospital was a two-day walk from the village. Daulaire and others treated her pneumonia with antibiotics, but Laxmi did not respond to them.

Laxmi had encountered multiple episodes of diarrhea, acute respiratory infections, fevers and a case of measles before she finally contracted pneumonia and died.

"When you work in this field, you try to understand why someone has died so you can get a sense of what you can do to prevent this in others for the future," Daulaire explained.

Daulaire has since developed a program to extend practical and inexpensive pneumonia treatment to poorer areas of the world.

The program trains villagers to diagnose pneumonia using an hourglass timer to count the number of breaths a child takes in one minute. If the villager counts more than sixty breaths per minute, then it is most likely that the child has pneumonia.

Of course, no discussion of health care could be complete without mention of the AIDS.

"AIDS orphans are a sobering and worrying part of the global dynamic," Daulaire said, adding that over 40 million orphans are projected to be AIDS-infected by 2015.

Daulaire said that in some African countries, the likelihood that an adolescent woman will die from AIDS is greater than the chance that she will live life HIV-free. In a study at one Kenyan high school, one-third of the girls were HIV-infected by the time they turned 19. These students contracted HIV from older men, which is the growing nature of the epidemic, Daulaire said.

"The focus is clearly going to have to be on preventing the infection even more than we want to treat the infection, because treatment is not a cure," he explained.

One mode of prevention Daulaire advocated was the female condom, which he said a woman can use without her husband knowing. Practitioners are currently working on a microbicide for women that would serve a dual purpose as prevention against AIDS and as a contraceptive.

These preventive measures would be most effective in the bottom one-fifth, by life expectancy, of the world's countries, where the average person is expected to live 48 years, Daulaire said. In the same bottom one-fifth, according to Daulaire, children are 20 times less likely to live to the age of five than in the United States.

If current trends of disease intervention continue, Daulaire said that life expectancy in these countries could drop to 33 years.

"That is a sobering reality indeed when you consider where they're starting from," he said.

Daulaire concluded his speech emphasizing the responsibility that politics holds in relation to public health.

"You can't segregate science from trying to make changes," he advocated.

"I try to remind people that there are profound political and social responsibilities that go along with the affluence and technological means we have," he said.

To bring levity to the somber topic of his lecture, Daulaire interjected quips and personal anecdotes amidst the impersonal statistics. He related the material to the studies and interests of students, and he shared the experience of his daughter, a pre-med student at Brown, who was in the audience.

For those students who sought experience in global health, Daulaire conceded that there is not a direct career path, but praised the Peace Corps as a means of immersion in another country.