The cost of 18 hours of war - Recent media

Statistics and political ramblings are not the purpose of this blog, so you will have to forgive me for this entry, as it drifts from this...a little bit.

I was recently emailed an editorial by Dr. Fitzhugh Mullan. It was published in last week's JAMA (thanks for the link, Gordon), and I wanted to briefly comment on it.

The article includes some well-understood global health numbers: Sub-Saharan Africa has 11% of the worlds population, 24% of the world’s disease burden, 60% of the world’s HIV, and 3% of the world’s health workforce. An example: there is a physician for every 390 patients in the U.S., and one for 33,000 in Mozambique.

This is a complicated problem, and one that I do not know how to solve. However, I do agree with Dr. Mullan’s assertion that “There can be no meaningful response to HIV/AIDS without sufficient health workers to plan, implement, and sustain the effort.”

Such statements are easy to agree with.My employer, BIPAI, also agrees, and responded to these numbers by creating the Pediatric AIDS Corps to provide HIV/AIDS care and health worker training in some of Africa's highest-prevalence countries, all in collaboration with local health professionals.

We are over here "planning, implementing, and sustaining" as we are able. I believe we are doing so meaningfully, but we are few.

Dr. Mullan’s article supports the creation of a US Global Health Service, modeled after the Peace Corps, to tap into the immediate “readiness of US health professionals to help” address workforce shortages. He argues that, through teaching, training, system design, and informatics, the result will be a "multiplier effect" benefiting health system development and capacity building.

This sort of direct assistance has its critics. The education and maintenance of a country’s health force, they rightfully argue, must stem from local governance, namely the national Ministry of Health. The support of such institutions is therefore critical indeed.

Meanwhile, as I sit here and write, I hear other voices.

Down the hall from me, a dozen of the Swaziland Ministry of Health‘s leading nurses are being taught by an U.S.-trained physician to collect dried blood spots for newly-funded HIV PCR testing. They will in turn train others.

Later this week, I am carpooling with a colleague of mine and several African physicians from Mbabane Government Hospital’s overwhelmed pediatric ward to visit a successful malnutrition program in another region of Swaziland. After the trip, we plan to sit and share ideas about improving MGH’s struggling feeding program.

These two examples themselves prove nothing, but they are two instances among hundreds that have convinced me that the multiplier effect exists, and that our being here has this type of effect.

A 2005 Institute of Medicine report estimated the cost of a US Global Health Service at 3.8% of the 3.9 billion proposed budget for the President’s Global AIDS Initiative in 2007, or roughly the cost of 18 hours of the Iraq war.

I am not a foreign policy expert or a national security buff, and I am forever humbled by how complicated a place the world is.

I am also humbled by the first line of Dr. Mullan's editorial: “HIV disease is essentially the black death of the 21st century, killing on a massive scale and threatening to cripple economies and topple governments.”

This disease is nonpartisan. It does not draft budgets or seek votes. However, it has political characteristics. It is calculating and clever, influential and strategic.

Oh, and quite threatening.

If our politicians do not do the math and prioritize accordingly, this virus will do it for them, for this epidemic’s mission does not drift.

JAMA article link: "Responding to the Global HIV/AIDS Crisis: A Peace Corps for Health"