Grants are provided by the US Agency for International Development (USAID) to private volunteer organizations (PVO) to teach health workers in the poorest communities of developing countries about the growth monitoring of children, oral rehydration therapy, breastfeeding, and immunization. Trained workers of these child survival programs then emphasize preventive health care in the community. Child survival programs also include interventions in different areas, education programs, and economic development schemes. The Johns Hopkins University (JHU) School of Hygiene and Public Health's Child Survival Support Program over the past ten years has managed 199 of these grants worth a total $15 million per year. PVOs are typically strong in identifying people most in need of help and getting resources to them. The 15-person JHU staff therefore simply selects grant recipients, trains PVO workers, and monitors recipients' expenditures in the field. PVOs in the program must account for every penny they spend, specifying the money spent per resident within a community, the number of mothers educated, children vaccinated, and lives saved. USAID, JHU, and PVO representatives from sixteen countries met for one week in early October 1994 on the outskirts of Bangalore in Karnataka State, India, to show how they have helped children in the world's poorest communities. The projects overall have reduced the child mortality rate at project sites by an estimated 50% with an average cost of $1.92 per person served. Measles, pneumonia, respiratory infections, and malaria, however, remain major causes of infant and child mortality. AIDS is a relatively recent and deadly challenge to child survival. The author stresses the need for local communities, governments, organizations, and local health personnel to work together to ensure that project accomplishments carry over once PVOs close shop in any given community. The background and activities of a female health worker from Nawapur are described.
There is no 1 AIDS epidemic in the US. The 1st epidemic includes gay and bisexual men. The 2nd consists of intravenous (IV) drug users and their infants, pimps, lovers, and customers. The 3rd and most recent epidemic affects individuals who are exclusively heterosexual who have never had a blood transfusion, never used IV drugs, and have not had sex with those who did any of these things. The former director of the Center for AIDS Research in Baltimore, MD put out 8 proposals that, if implemented, would reduce the transmission of HIV and provide adequate medical care for AIDS patients. Health and educational professionals must develop improved AIDS education programs directed to those at risk. Since many of them are functionally illiterate, television should carry AIDS education messages. In addition, all AIDS prevention and educational programs need to be evaluated strongly so the country can focus on those activities which are most effective. Those who determine public policy should heed the advice of those who truly understand AIDS. Government, drug companies, and university scientists should all increase research to develop antiretroviral drugs that are not dependent on refrigeration, can be transported rapidly, and are inexpensive. Scientists also need to continue working on a vaccine and determine if an HIV vaccine can indeed immunize entire populations. Moreover affordable health care must be available to all AIDS patients. The present haphazard structure of AIDS treatment services must be recognized and integrated into a system that provides patients with coordinated medical and social services. Likewise, all research, treatment and education programs at federal, state, and local levels must be coordinated so that various players do not bicker over priorities.
Physicians and researchers at Johns Hopkins Hospital and other medical centers continue to explore the complex issue of fetal viability. Attempts to save fetuses often point to developments and limits of viability. An emphasis is placed on studying the most distressed organs in premature infants, namely the lung, kidney, and brain. Lungs, being the last vital oral to develop, are most essential in determining viability and infant survival. Research is experimenting with surfactant in drug form to threat premature infants. Karen Blakemore, a Hopkins obstetrician, studies fetal kidney and bladder. In treating these infants with a procedure called in utero, excreting urine because of a blockage in the urethra. Blakemore closes in on the issue of infant viability, as the procedure can only be performed 18-20 weeks of gestation. Treatments of the fetal brain points also to viability as most brain hemorrhage in newborns occurs in about 40% of deliveries less than 28 weeks of gestation. Most neonatologists, and obstetricians, as well as legislators agree, that the question of viability as viewed exclusively by lawmakers, has no real definitive answer. Physicians are stressing the need for more medical facts in the debate over infant viability.
The reuse of unsterilized syringes is spreading AIDS, hepatitis B and the African Ebola-Marburg virus. In the US 25% of the AIDS cases are related to intravenous drug abuse. In developing countries syringe reuse is related to poor health care delivery systems. In these countries syringes are used over 5 times before sterilization; in some countries the syringes are distributed by people who sell injections of vitamins and antibiotics. In 1986 Halsey challenged the medical community to design a syringe that would not transmit these diseases, and shortly thereafter a separate challenge was issued by the World Health Organization. The requirements of this syringe are its self destruction after use, little requiring retraining of medical personal, and no more than 1 cent to the cost, and be simple to make. These challenges brought 70 various syringe entries and all but 3 were eliminated. The Hopkins syringe is similar to a regular syringe except it has a polymer insert that seals up after one use. When water flows around the polymer insert it swells and closes off the passageway preventing any liquid from flowing in or out of the syringe. Another syringe seals up in 2.5 minutes which allows the health worker time to draw and inject a patient before the syringe destructs. By using hydrogels that are already approved for use in contact lenses and food substances, the safety has been tested. Companies looking at production costs estimate that the polymer insert will add only 1/4 of a cent to the cost of a syringe.
This article, based on information from specialists at Johns Hopkins, poses and then answers 3 broad questions about the acquired immunodeficiency syndrome (AIDS). 1st, it is asked, "What is AIDS and how serious is it?" It is noted that AIDS is only 1 of several forms taken by infection with the human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). The earliest form of infection is believed to occur within a few weeks of exposure to the virus, and some patients develop an acute syndrome that resembles infectious mononucleosis. These symptoms disappear after 4-6 weeks, by which time the patient has developed antibodies to the virus. About 2-4%/year of asymptomatic carriers go on to develop AIDS-related complex (ARC), and 15-30% of ARC patients develop AIDS within 5 years. The 2nd question posed is, "How do you catch AIDS?" To cause infection, the virus must go directly into the blood, although the virus alone may not be enough to cause sickness. Previous viral infections such as hepatitis B, herpes, cytomegalovirus, and intestinal parasites have been suggested as co-factors of AIDS. Promiscuity increases the chances of contracting AIDS. Observations of the families of AIDS patients and health care personnel who work with AIDS patients suggest that AIDS cannot be caught by casual contact. Finally, it is asked, "What is being done about AIDS?" 4 strategies are outlined: 1) as a result of donor screening for antibodies to HTLV-III/LAV, AIDS has been completely removed from the blood banks; 2) virologists are attempting to understand the virus so that it can be attacked, and understanding has been advanced by the theory that HTLV-III might be what is called a "slow virus;" 3) education about AIDS is changing the sexual practices that transmit AIDS; and 4) epidemiologists are carefully following those who are at risk, have been exposed, or are already sick.
