The term neglected illnesses is now a well- known terminology for many diseases in the developing world that continue to become a scourge without any help in sight. The academic understanding however of many of these neglected diseases has certainly improved. Some years ago the prestigious medical journal “Nature” published the genomic sequence (decoding) of the organism which caused plague ( Black Death) in the middle ages. The bacteria was reconstructed from the medieval plague victims. Genome sequencing of many organisms has happened rapidly, but has this “basic science” enhancement of our knowledge helped us now in a practical sense? Not really.
About twelve years ago genomic sequencing of the typhoid bacteria was carried out. Many scientists at that time wrote ecstatically about how this sequencing would lead to revolutionary changes in typhoid fever treatment. Sadly twelve years hence we have made no obvious progress in taking care of our typhoid patients. The academic thrill of discovery did not translate to more effective patient outcome.
Because typhoid can affect anyone in Nepal ( from highly-placed officials to high- altitude climbers to school children), we all continue to suffer from the lack of prompt, proper diagnosis and treatment for this ubiquitous disease despite a huge gain in theoretical knowledge. What happened?
After the laboratory scientists sequenced the typhoid bacteria they moved on to other “virgin territories” in sequencing.
The problem is that these diseases like typhoid, typhus, rabies, hepatitis E, and snake bites really do not have a spokesperson or lobby groups and are truly considered biblical diseases generally confined to the developing world. There is, for example, no financial incentive to take advantage of the typhoid bacterial sequencing to make cost-effective, accurate diagnostic tools to help with patient care in typhoid fever.
Compare typhoid fever with HIV disease which continues to make important gains in prevention and treatment. This favorable bias towards diseases like HIV is obvious in the funding pattern of the US National Institute of Health (NIH) and even the Bill and Melinda Gates Foundation. Of course if we had clean drinking water and improved sanitation and plumbing, typhoid would disappear; but tremendous political will is required for this.
With the summer months come a host of Nepali summer diseases such as hepatitis which has already started causing problems in Biratnagar.This hepatitis is reported to be hepatitis A or E, but the available rapid diagnostic tests are not always reliable and many cases of hepatitis E may be missed. And sophisticated tests like PCR ( polymerase chain reaction) are generally expensive and unavailable in Nepal, so many times a proper diagnosis does not get made which obviously will hamper proper management of the case.
The deadly snake bite, an absolutely neglected problem rampant in the Terai is for sure going to re-appear this summer. But year after year there continues to be a shortage of life- saving anti- snake venom. For us in Kathmandu just thinking about snake bites is enough to give us sleepless nights. Imagine then the reality where snakes slither beside you while you remain asleep on the floor. Public health measures and adequate supply of anti- snake venom are clearly going to save lives of many farmers and their families.
Rabies is not a seasonal disease and is generally present in the same intensity the year around. But thankfully at least for dog bite victims the Nepal health ministry administers the expensive anti rabies vaccine for free. A word about rabies.
Often rabies affects children and even a small puncture wound by a rabid dog’s teeth in the finger may potentially cause rabies. So it is crucial to obtain the vaccine and importantly also to clean the dog bite wound with soap and water and iodine very carefully as the rabies virus tends to stay at the bite site.
For these neglected tropical diseases in the Indian subcontinent, like snake bites and rabies, concerted help from dedicated groups like the Bill and Melinda Gates Foundation would certainly go a long way in rectifying these problems.