Global health security and sustainability

• Choose one of the 5 case studies presented at the start of this subject. • What needs to change/occur by 2040 to ensure that the outcome of this case is benign– the subject of the case avoids death or disability. • Analyse plausibly and specifically what would need to change between now and 2040: what it would take to achieve this good outcome. Possible areas to address in" rel="nofollow">include but are not limited to: Five case studies: 1. Emília Machaieie: Emília Machaieie was born and lived for 11 months and 15 days in" rel="nofollow">in the village of Mabuia in" rel="nofollow">in Mossurize District in" rel="nofollow">in central Mozambique. She was the fourth child of her 25-year-old mother and 28-year-old father. Her family farms a small plot recently cleared from the low dry forest around a riverbed that is marshy after the annual rain" rel="nofollow">ins. They mostly plant cassava, usin" rel="nofollow">ing the leaves to make various sauces, and carefully soakin" rel="nofollow">ing and dryin" rel="nofollow">ing the roots (to remove the natural cyanide that helps make cassava such a pest resistant crop) to make a thick porridge that is their staple diet. Emilia did well for her first four months. Her mother gave her breast milk and nothin" rel="nofollow">ing else, and her weight rose steadily along the optimum trajectory. Once she started on weanin" rel="nofollow">ing foods, however, thin" rel="nofollow">ings started to go wrong. Durin" rel="nofollow">ing the wet season her family used water from the river, and when that dried up a couple of months later her mother walked 800 m each day to draw about 20 L of water from a hand dug well shared with the rest of the village. The water was commonly contamin" rel="nofollow">inated, and it was never enough (especially in" rel="nofollow">in the dry season) to wash hands, eatin" rel="nofollow">ing, or cookin" rel="nofollow">ing utensils properly. At five months of age Emília had her first bout of watery diarrhoea. She lost weight but survived. However the low energy density of her weanin" rel="nofollow">ing foods meant that she never managed to recover the lost weight, and the regular bouts of diarrhoea every few weeks from then on meant that by 11 months of age she weighed only 5 kg – little more than she weighed at five months. Emilia's parents were very worried as they saw her grow weaker in" rel="nofollow">in her fin" rel="nofollow">inal bout of illness. They thought of takin" rel="nofollow">ing her to the health centre in" rel="nofollow">in Espungaberra, but they knew that would in" rel="nofollow">involve a full day's walk. There is no road suitable even for four-wheel-drive vehicles within" rel="nofollow">in 15 km of Mabuia, and is no regular transport even from there on to the district capital. Instead, they gave her a traditional remedy made from local roots but although the diarrhoea became less frequent she weakened further and died on the third day of her illness. 2. Sothearum Tong: Sothearum Tong was born in" rel="nofollow">in Bantaey Manchaey provin" rel="nofollow">ince in" rel="nofollow">in Cambodia. She lived with her parents on the outskirts of Sisiphon, a small town that was strategically important durin" rel="nofollow">ing the Khmer Rouge period in" rel="nofollow">in Cambodia, and especially in" rel="nofollow">in 1979 when the Vietnamese military in" rel="nofollow">intervened and drove the Khmer Rouge from power. At some poin" rel="nofollow">int durin" rel="nofollow">ing that poorly-documented conflict one or other of the two sides planted hundreds of anti-personnel land min" rel="nofollow">ines in" rel="nofollow">in a defensive arc around the town. However, no records have survived of exactly how many min" rel="nofollow">ines were laid, nor of where they are. The children of the town are taught from an early age to avoid known min" rel="nofollow">ine fields, and large areas have been officially de-min" rel="nofollow">ined. But somehow 6-year-old Sothearum strayed in" rel="nofollow">into a field with at least one unmarked, unexploded min" rel="nofollow">ine. Even her slight weight was enough to detonate the min" rel="nofollow">ine, and she immediately lost her left foot as far as the knee. Other pieces of shrapnel struck her right leg, abdomen and face. Although her older brother was nearby and was able to rush her to the local health centre for care, she spent two months in" rel="nofollow">in hospital and fin" rel="nofollow">inally emerged min" rel="nofollow">inus one leg, and blin" rel="nofollow">ind in" rel="nofollow">in her right eye. 3. Fatima Samadzai: Fatima lived all of her 28 years in" rel="nofollow">in the village of Khosh Nazar in" rel="nofollow">in Khas Uruzgan district in" rel="nofollow">in Uruzgan Provin" rel="nofollow">ince in" rel="nofollow">in central Afghanistan. She married at 15, workin" rel="nofollow">ing in" rel="nofollow">in the home of her husband’s extended family, who grew wheat, other crops and kept a herd of goats. Durin" rel="nofollow">ing the Taliban rule in" rel="nofollow">in the provin" rel="nofollow">ince she was unable to contin" rel="nofollow">inue attendin" rel="nofollow">ing primary school and thus remain" rel="nofollow">ined illiterate. Fatima and her family were pleased each time she fell pregnant, and by 25 she had four children, each born at home. At 27 she embarked on her 5th pregnancy. Fatima received no antenatal care given the difficulty of accessin" rel="nofollow">ing it; her mother-in" rel="nofollow">in-law felt it unnecessary and in" rel="nofollow">in any case it was costly and took the best part of a day to reach. Intermittent fightin" rel="nofollow">ing between Australian military forces and Taliban fighters had made roads even less safe and travel difficult. An Improvised explosive device killed two members of a neighbourin" rel="nofollow">ing family on their way home from market the previous week. Fatima went in" rel="nofollow">into premature labor at 34 weeks, and was attended by her mother-in" rel="nofollow">in-law and an older woman in" rel="nofollow">in the village who served as a traditional birth attendant. After several hours of labor Fatima developed acute severe abdomin" rel="nofollow">inal pain" rel="nofollow">in, as if multiple knives were cuttin" rel="nofollow">ing in" rel="nofollow">inside her womb. She become distressed and began to bleed profusely. It was growin" rel="nofollow">ing dark and it was win" rel="nofollow">inter. The nearest hospital was 2 hours by foot or donkey and then at least 6 hours by road if a vehicle could be arranged. Despite the danger and difficulty of travellin" rel="nofollow">ing at night, the birth attendant realized after half an hour of uncontrollable bleedin" rel="nofollow">ing that Fatima was in" rel="nofollow">in mortal danger. After consultin" rel="nofollow">ing with village elders they set off with Fatima on the family donkey, but half an hour in" rel="nofollow">into the journey she expired from loss of blood. 4. Michael Matane: Michael Matane would have been three years old had he lived another three months. He was the first child of his 20-year-old parents, and lived on the outskirts of Moro, a small town in" rel="nofollow">in the Southern Highlands provin" rel="nofollow">ince of Papua New Guin" rel="nofollow">inea. His family farm a small hill-side plot, movin" rel="nofollow">ing from one area to another each year 'slashin" rel="nofollow">ing and burnin" rel="nofollow">ing' to create a new fertile area from the bush. They grow sweet potato and other crops, coverin" rel="nofollow">ing their family's food needs and generatin" rel="nofollow">ing a small surplus to sell in" rel="nofollow">in the town market to earn money for their other needs. Michael's father sometimes supplements the family's diet by huntin" rel="nofollow">ing small animals. His skill with the bow and arrows brin" rel="nofollow">ings him local recognition and respect. Michael was exclusively breast-fed for six months, but then his mother fell pregnant again" rel="nofollow">in and he was rapidly weaned. His growth began to falter and he had a series of fevers. His mother took him each time to the local government health centre and he recovered each time with antimalarial drugs. His last illness was different, though. It began with fever and a little cough. He stopped eatin" rel="nofollow">ing, and even had trouble drin" rel="nofollow">inkin" rel="nofollow">ing. It was clear that he had trouble breathin" rel="nofollow">ing, and he was breathin" rel="nofollow">ing very fast – at least seventy times per min" rel="nofollow">inute. His mother took him to the health centre but the health worker was puzzled, and sent him home with only a cough syrup. He contin" rel="nofollow">inued to deteriorate durin" rel="nofollow">ing the followin" rel="nofollow">ing night, and to his parents' in" rel="nofollow">increasin" rel="nofollow">ing distress, weakened and died shortly before the dawn. 5. Yusuf Khan Yusuf Khan is a 52 year old farmer who lives with his wife, 4 of his 7 children, and 3 of his 13 grandchildren in" rel="nofollow">in the Dharavi slum in" rel="nofollow">in Mumbai. The family moved to Mumbai in" rel="nofollow">in 2006 when they were displaced from the land they had farmed for generations by the construction of the Sardar Sarovar Dam on the Narmada River in" rel="nofollow">in Navagam, Gujarat. In Mumbai, he worked as an auto rickshaw driver to support the family and his wife supplemented the in" rel="nofollow">income by workin" rel="nofollow">ing as a domestic help. Mr Khan has reduced lung function related to past tuberculosis (now in" rel="nofollow">inactive) and smokin" rel="nofollow">ing tobacco. Soon after the family moved to Mumbai, he developed diabetes. Mr Khan sought medical care from the local ‘pharmacy’ however his diabetic treatment was erratic and control of his diabetes poor. He was also found to have high blood pressure thought to be related to diabetic kidney disease. Mr Khan was no longer able to work as an auto-rickshaw driver because of a stroke that caused paralysis of the left-side of the body. Subsequently, his 2 children had to withdraw from school to work in" rel="nofollow">in a ‘beedi’ factory to help earn in" rel="nofollow">income to cover Mr Khan’s medical treatment costs. His wife and children help care for Mr Khan who is now severely disabled and needs help with most domestic tasks.