Medical Workers, Global Health's 'Boots on the Ground'

The mission of improving health around the world largely rests with "boots on the ground" — the trained people who deliver medical care. As part of NPR's series of reports on global health, Day to Day presents audio vignettes on the challenges facing health care workers in Indonesia, Brazil, El Salvador and Ghana.

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MADELEINE BRAND, host:

This is DAY TO DAY. I'm Madeleine Brand.

This week, National Public Radio is taking a special look at global health issues. Today on the program, we introduce you to four health-care workers who are struggling to cope with some of the world's biggest threats. In a moment, you'll hear about AIDS in Ghana, dysentery in El Salvador and bird flu in Vietnam. But we begin in Brazil, where one researcher is trying to stop a devastating parasite. Here's NPR's Joe Palca.

JOE PALCA reporting:

Imagine a parasitic worm that attaches to the lining of your intestine and sucks your blood from the inside. You've just imagined hookworm.

Mr. JEFF BETHONY (Parasitic Disease Specialist, George Washington University): Seventy, 80 percent of all these people are infected. They maintain their lives here. They work. They do everything, and so their bodies adjust to having the parasite.

PALCA: Jeff Bethony is visiting a cluster of homes outside of Americaninus(ph) in the Brazilian Highlands. Bethony's a parasitic disease specialist from George Washington University. He's been working in this part of Brazil for the past year. His goal is to develop a vaccine to prevent hookworm. Bethony says the parasite is insidious.

Mr. BETHONY: The effects are subtle, but important. I mean, there's a lot of problems with their growth and development. There's a lot of problems with cognition and learning abilities in the children. There's a lot of long-term chronic effects in terms of other kinds of diseases that they'll get. And only now are we realizing the possible economic impact. So I think the risk to any one individual--although it's hard to portray. The overall burden of this disease is enormous in economic, educational, social and health terms.

PALCA: You get hookworm from coming in contact with soil that contain the worm larvae. Bethony says in poor areas like this, where children play in contaminated soil and adults plant crops in it, avoiding infection is nearly impossible.

Mr. BETHONY: There tends to be this idea that if you just bought everybody shoes, you could eliminate hookworm...

PALCA: Yeah, that's not...

Mr. BETHONY: ...and that's not true at all.

PALCA: Yeah.

Mr. BETHONY: We don't even find that it's a risk factor, whether they wear shoes or not. Poverty's the biggest risk factor.

PALCA: Short of ending poverty, Bethony says the next best way to control hookworm is a vaccine. He hopes to test the new hookworm vaccine here next year.

(Soundbite of birds)

ALISON MacADAM reporting:

I'm Alison MacAdam. On the outskirts of Ghana's capital city, Accra, a dusty alley runs between factories and warehouses. In an office here with lime green walls, one Ghanaian runs a support group for women living with HIV and AIDS. Her name is Bernice Heloo.

Ms. BERNICE HELOO: Not `hello.'

(Soundbite of laughter)

Ms. HELOO: I thought that when you saw that, you'd say `hello.'

MacADAM: At Bernice's, women can get a hot lunch, sometimes financial help for buying AIDS drugs, and companionship. Bernice calls it psychosocial support. The drugs, she says, have nearly brought people back from the dead, but she calls them a last resort. Bernice prescribes a more abstract medicine for staying live with the HIV infection: positive living.

Ms. HELOO: You've got to make the best out of life and especially in that, that you are different from other people. Life must go on, and I have seen that those who are really--how ...(unintelligible) it this way--strong, since we established these groups, the number of deaths is not so much.

(Soundbite of voices)

MacADAM: Across the street, in the shade of a large brown shipping container, the women sit around a table. They eat, chat and string red beads into the shape of AIDS ribbons. Many of the members of the group, called Pro-Link, lost their jobs due to the disease. Now, together, they make businesses out of selling Coca-Colas, the beaded ribbons and batik.

Ms. HELOO: We try to help as much as we can. We offer a lot of love and compassion, and as you can see, we are very happy women. So all these are babies of Pro-Link. Yes. So what do you call me?

Unidentified Child: Mama. Mommy.

Ms. HELOO: Mommy. (Laughs) Yes.

Unidentified Child: Mommy. Big Mommy.

MacADAM: The group is like a family, and not just for the women with AIDS, but for Bernice Heloo herself.

Ms. HELOO: Why you come again? You see how we are doing.

(Soundbite of voices)

JON HAMILTON reporting:

I'm Jon Hamilton. In El Salvador, hygiene is a matter of life and death. Contaminated food and water kills thousands of Salvadorans each year. Children are most vulnerable. So government health-care workers have become hygiene educators. This is a story about one of those workers.

Ms. MELITTA SORTO (Public Health Worker): (Spanish spoken)

HAMILTON: Melitta Sorto is El Salvador's version of a public health nurse. She works in a small community near the coast in the department of La Paz. Not long ago, a child in her district nearly died from intestinal parasites.

Ms. SORTO: (Spanish spoken)

HAMILTON: She was a four-year-old girl named Annalise(ph). Her mother knew the girl was sick, but didn't have money for a doctor. Annalise kept getting worse. Eventually, her mother borrowed the money to hire a car that would take her daughter to a hospital in San Salvador. Sorto says by the time Annalise got there, she was dehydrated and nearly unconscious. Her eyes were sunken; her tongue was swollen. Annalise recovered, but Sorto was afraid she would get sick again if her living conditions didn't improve, so she visited the girl's house and she began teaching Annalise's mother about hygiene.

Ms. SORTO: (Spanish spoken)

HAMILTON: Sorto explained that water for drinking or cooking had to be boiled. She explained that dogs, pigs and cattle can carry parasites and must be kept away from the family's living area. She explained that cleanliness can prevent diseases, like the one that almost killed Annalise. Sorto said her work paid off.

Ms. SORTO: (Spanish spoken)

HAMILTON: The children haven't gotten sick since their mother began following her recommendations.

REBECCA DAVIS reporting:

I'm Rebecca Davis. At the Bakmai Hospital in downtown Hanoi, Dr. Nguyen Tran Vanh(ph) walks briskly down the corridor in her low-heeled pumps.

(Soundbite of footsteps)

DAVIS: She's just over 5', in her late 40s. Dr. Vanh passes one cluster of hospital beds after another and then, at the very end of this hallway, she stops beneath a sign that reads `Isolation Area.' It's posted in front of a room with open doors and open windows. Relatives of sick patients stream in and out. Dr. Vanh points towards a bed near the door.

Dr. NGUYAN TRAN VANH (Bakmai Hospital): (Through Translator) He was brought to this bed right here, bed number 12.

DAVIS: The patient in bed number 12 was one of Dr. Vanh's most recent cases of avian flu, but he certainly wasn't her first. Dr. Vanh has treated dozens of avian flu cases, probably more than anyone else in the world. So when this young man showed up earlier this year with a high fever, desperate for breath and an X-ray that showed foggy white lungs, she knew another case of the deadly avian flu had crossed her threshold.

Dr. VANH: (Through Translator) He was brought as an emergency case. You know, only the most serious cases are referred here.

DAVIS: The patient in bed number 12 stayed under Dr. Vanh's care for 72 days. He left this hospital a survivor of the disease that kills nearly half of its victims. So this no-nonsense woman can imagine more than most what a pandemic strain of that flu might do to the human population. But ask her if she's worried about an outbreak of a pandemic flu and she just shakes her head no.

Dr. VANH: (Through Translator) I think we should be more concerned with thousands of people who are killed by tsunamis and earthquakes, natural disasters that we can't do anything about but that kill a lot of people. We can do something about these emerging diseases. With all the advances made in medicine, I believe this disease can be controlled by humans.

DAVIS: Maybe she's too optimistic, but perhaps she's earned this optimism one desperately ill patient at a time.

(Soundbite of footsteps)

BRAND: We heard from Rebecca Davis in Vietnam, Jon Hamilton in El Salvador, Alison MacAdam in Ghana and Joe Palca in Brazil.

Global health coverage continues tonight at 9 PM with "RX for Survival," a special television series on PBS. Check local listings.

More to come on DAY TO DAY from NPR News.

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