Posts Tagged ‘Peru’

The Plague: Timely Treatment is Critical

Thursday, August 5th, 2010 by Frank Gillingham, MD

In an eerie throwback to a bygone era, the Peruvian minister of health reported on Monday that a 14 year old boy had died and that at least 31 others had become infected with the plague last week.  The vast majority were of the bubonic (lymph node) type – spread by fleas – while a small number suffered from the pneumonic (lung) variety spread by airborne bacteria.

Although the plague is treatable with antibiotics, the lack of timely intervention can be deadly, particularly for the pneumonic type.  Untreated, the mortality from either form of the plague approaches 75%, and is thought to have been the cause of  Black Death – the mid 14th century epidemic that killed over 25 million people, or one third of the population of Europe.  Epidemiologists believe that it was the bubonic type, spread by fleas hosted by rats, that was responsible.  

So far, the cases in Peru have been confined to the Northern coastal province of Ascope, located approximately 325 miles northwest of Lima.  The popular international resort of Chicama beach is not far away. Health Minister Oscar Ugarte has ordered authorities to screen sugar, fish and meat exports from this area. 

There is no vaccine available for the plague.  Both the bubonic type, which results in swollen, painful lymph nodes, and the pneumonic type, which causes a rapidly progressive pneumonia, can progress without treatment to involve the entire body.  This third, or septic form, results in fever and chills, abdominal pain, vomiting, diarrhea, bleeding from the mouth, nose or rectum, shock and ultimately blackening and death of tissue (gangrene) in the extremities.  This darkening of fingers toes and the nose lead to the coining of the term “Black Death” over 500 years ago.

Anyone who has traveled to an area endemic for the plague should seek immediate medical attention for any flu like symptoms since early treatment with antibiotics is over 90% effective in preventing the more deadly consequences of this historic illness.

Photo by markfftang

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Multi-drug Resistant TB: Where Is It Winning?

Friday, July 23rd, 2010 by Mike Hartung

My eyes were opened to the threat posed by multi-drug resistant tuberculosis (MDR-TB) when I read about Dr. Paul Farmer’s evangelical efforts to raise the world’s consciousness in Tracy Kidder’s book Mountains Beyond Mountains.  Years later I’ve learned the threat continues to grow. The World Health Organization works very closely with Farmer’s Partners In Health organization to monitor and combat MDR-TB around the world.  The WHO’s 2010 report is cause for alarm but also offers some seeds of hope.

First some worldwide statistics from the report:

  • In 2008, there were estimated 440,000 MDR-TB cases and 150,000 deaths
  • Only 7% of all MDR-TB patients were diagnosed and notified
  • 60% of those enrolled in treatment programs were cured
  • In 2010, only 22% of the $1.3 billion needed to fund MDR-TB control is available
  • In 2015, funding required to control MDR-TB will be nearly $4.5 billion

How did we arrive at this dangerous place?

Tuberculosis thrives in the poorest neighborhoods and in prisons and hospitals that house the poor.  Treatment with antibiotics is effective, but the course of treatment is long, and the side effects can be serious.  Therefore, it is not unusual for patients to abandon their antibiotics too early, giving rise to the MDR strain.  Today the prevalence of MDR-TB is growing, and so is the risk of encountering it on your travels, especially if you are visiting any of the 27 countries with a high burden of TB.

See the chart below for the prevalence of MDR-TB in these countries and the number of cases annually.  Travelers should also note that MDR-TB has a significant foothold in Jordan and Peru.  Further, only 22 of 46 African countries provide data to the WHO.

On the hopeful side, treatment efforts seem to have turned the tide in Estonia, Latvia, Hong Kong, the U.S. and certain parts of Russia. Twenty of the 27 high burden countries are strengthening their efforts by scaling up access to diagnostic tests.  As is so often true, sustained progress depends on increasing resources, expertise and coordination around the globe.  The price tag to control MDR-TB is relatively affordable when compared to global expenditures to combat HIV and H1N1, but until the problem reaches crisis proportions, adequate funding may not materialize.

And don’t bet against the microbes.  They have continued to evolve to elude even more forms of antibiotics.  The Extensively Drug-Resistant (XDR-TB) strain has now appeared in 58 countries, and the WHO estimates there are 25,000 cases annually.

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Mudslides in Machu Picchu

Tuesday, January 26th, 2010 by Moira Bishop

The heaviest rains to hit Peru in the past fifteen years have caused mudslides with serious consequences today — 4 people have been killed and 2,000 tourists have been stranded in and around Machu Picchu.

Reports from our contacts at Pardo Medical Center based in Cusco, Peru indicate that the heavy rain is not letting up and that is causing problems for transportation.  The trains are not running and the Cusco airport is closed until at least tomorrow, so the only way out is by helicopter.  The clinics are open for anyone who can get to them. 

Like many natural disasters, mudslides cannot be predicted.  If you are visiting or planning to visit a mountainous — or even just hilly — region that has recently experienced heavy rainfall or snowmelt, you may want to reconsider your plans.  

Ideally, you will never be in the path of a mudslide, but just in case, it’s a good idea to note these instructions from the Red Cross:

  • Quickly move out of the path of the mudslide or debris flow.  Moving away from the path of the flow to a stable area will reduce your risk.
  • If escape is not possible, curl into a tight ball and protect your head.  A tight ball will provide the best protection for your body.

Though you don’t want to spend time dwelling on worst case scenarios while preparing for vacation, a few minutes of planning can prove to be invaluable.

Photo info: http://www.flickr.com/photos/comprock/ / CC BY-SA 2.0
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Walking Into Trouble: Pedestrians in Peru (and Other Places)

Tuesday, July 28th, 2009 by Emily Moran

Worldwide, 46% of all highway fatalities are “vulnerable road users”-pedestrians, cyclists and people on two-wheeled motor vehicles, according to the recent WHO report on road safety.  But we’ve run some numbers and found that in Peru, for instance, pedestrians alone account for 78% of all highway deaths. In the U.S. and India that figure is 12%.

Travelers typically explore their new surroundings on foot, so we think it’s worth investigating where pedestrians run (or should I say walk into?) the highest risks. The chart below shows the countries where pedestrians make up the highest proportion of road deaths.

Look Both Ways - Pedestrians as % of Total Deaths

Look Both Ways - Pedestrians as % of Total Deaths

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

Joining Peru in the “top twenty” are countries as diverse as Mozambique, El Salvador and the Ukraine. When paired with similar countries, large disparities in risk appear. For instance, Peru (78%) and Ecuador (43%) are Andean neighbors; Mozambique (68%) and Kenya (47%) are East African cousins; El Salvador (63%) and Panama (46%) are Central American siblings, and the Ukraine (56%) and Belarus (40%) are almost Eastern European twins. Why the spread? We’re not sure, but it’s well worth noting.

Even if you’re not traveling to one of these high risk countries, it’s a good bet your pedestrian experience will be very different when you’re abroad, particularly if you’re exploring big cities. Traffic patterns may be novel, sidewalks may be limited, and stoplights or crosswalks are often inadequate or non-existent. Check out these videos of people crossing the street in Vietnam (no death rate data available!): this one has a nice view of traffic pattern, and this one shows the perils even on a crosswalk!

So, wherever you’re walking (and running these risks), here are a few tips:

  • Walk where cars can see you-not behind signs or bushes.
  • Wear visible clothing-resist the urge to wear black at night.
  • Look both ways! If cars drive on the right (like in the U.S.), look left first, then right, then left again before starting to cross. If cars drive on the left, look right, then left, then right again.
  • Face traffic when you are walking on the roads (especially on the more narrow ones) so that you can see approaching vehicles.
  • Assume the motor vehicle always has the right of way.

If you have any tip or experiences that you’d like to share, please do! 

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