BlessWorld Foundation International

Affecting the World Through Health
A Global Health Initiative

Archive for November, 2019

Wildfires are large, uncontrolled and destructive fires that spread quickly over woodland, brush or an area of combustible vegetation, mostly in rural regions. Depending on the kind of vegetation involved, wildfires may also be referred to as forest fires, grassland fires, bush fires, brush fires, urban fires or wildland fires. Wildfires could happen in most parts of the world except places like the Antarctica. Fire is always seen as a good servant and a terrible master; in the case of wildfires, it evolves from being not just a terrible servant but an enraged god causing loads of destruction to life, properties, environment and natural resources.

Wildfires can occur naturally and spontaneously due to factors like lightning and heat- extremely dry heat waves can produce enough heat to spark a wildfire. Dry weather and drought convert green vegetation into dry, flammable fuel; strong winds spread fire quickly over the land and warm temperatures encourage combustion. Additionally, humans also contribute to this disaster either accidentally or deliberately through campfires, careless cigarettes disposal, burning etc. According to the national interagency fire center, human beings cause about sixty one thousand eight hundred and fifty two (61,852) fires yearly.

Wildfires can burn hundreds to millions of acres of land at rapid speeds consuming everything on its path from trees to animals and humans. The largest single fire ever recorded was that of the 2003 Siberian Taiga fires- 27 million Acres of land engulfed in flames and about 47 people died, emissions from the fire equaled the emission cuts promised by the European Union under the Kyoto protocol. The scars caused by this fire are still seen in present day environmental studies on ozone depletion.

Some countries like Canada and Australia have accepted wildfires as an integral component in shaping their forests. Their ecological system has developed symbiosis with the fire which in turn affects the air quality and landscape. Wildfires and industrial activities result in the release of greenhouse gases which increase the level of heat through the depletion of the ozone layer- the heat in turn increases the rate to which the wildfires can occur. This causal sequence explains the increased frequency of fires around the amazon basin as well as the recent California fire outbreaks.

The war on climate change is far from ending if the problems of wildfires are not properly addressed. Wildfires pose immediate and serious public health threats to individuals living around the region and also to everyone on planet earth- there are already increased reports of respiratory diseases among Brazilian children.Wildfire prevention starts from different agencies that cover restrictions but ultimately depends on the behavior of the general public. In order to stop and reduce the rate or frequency of wildfires, regulating bodies need to be vigilant and enact the necessary laws and policies important in tackling this issue. Data of previous fire incidents should be continuously reviewed and compared with the weather forecast to recognize dangerous patterns so as to know how to manage them effectively. People living in fire susceptible areas should be well educated and constantly informed through various means of communication about any slight change in their environment. Programs like firewise, community wildfire protection plan and fire adapted communities are plans that work to protect people, properties and natural resources by emphasizing forest fire readiness and creating fire resistant community designs. These and more regulations will help in preventing and containing wildfires as well as minimizing spreads and damage to the environment.

Health care workers are often at increased risks of infections due to their immediate work environment. The potential risk to their health is an important public health issue that is particularly neglected in many developing countries. The 2006 World Health Report-Working Together for Health reported a severe health workforce crisis In fifty-seven (57) countries- most of them in Africa and Asia. In Nigeria for example, during the 2014 Ebola outbreak, Dr Stella Adadevoh and some other health care workers lost her lives while trying to prevent Ebola spread from Port Harcourt to Lagos and other parts of the country- sadly without receiving a national honour or credit for their efforts and bravery. It is a costly price for health workers to lose their lives in the course of their service but unfortunately, the list of healthcare workers that have lost their lives in a similar fashion is unending. There are various kinds of hazards to which health workers are exposed-they include, Biological hazards which is a group of hazards including infectious agents like Ebola mentioned above, HBV, HIV etc. Other forms of hazards can be physical hazards, chemical hazards and psychosocial hazards.

Biological hazards such as infectious agents pose serious risk to the lives of every health care personnel. These workers may be exposed through inhalation, contact with bodily fluids and more importantly, needle stick injuries. In fact, the WHO global burden of disease from sharps injuries to health-care workers showed that 37% of the hepatitis B among health workers was the result of occupational exposure. Sometimes, these are due to either mistakes from the health worker or poor disposal of wastes.

Health workers are also affected by physical hazards including fire and radiation as well as work related violence just like industrial workers. Fire hazards have been reduced due to widespread public health measures but there are still risks of harmful radiation exposure as radiation is a part of diagnostic medicine. Work related violence is a common problem in developing countries- studies have shown that over 90% health workers especially nurses, have been abused physically or verbally.

Chemical hazards from toxic substances used in routine medical practice mostly result in injury unlike biological hazards that can lead to death. Also, allergy from latex gloves is an important form of chemical hazard. Similar to biological hazards, they can also be due to mistakes from the health worker and poor disposal of wastes. Finally, there are psychosocial hazards that affect the mental health of health workers. These are mostly due to very long work time leading to physical and emotional exhaustion, low pay in developing countries and stress induced illnesses such as hypertension. These emotional hazards inflict invisible wounds that reduce the efficiency and efficacy of health workers. This is then reflected in the poor quality of care and health systems experienced by the public at large.

The WHO and other international health organisations continue to advocate for better occupational health through practices like use of post exposure prophylaxis, vaccination of health workers, increase in wages and trainings to prevent occupational hazards and its consequences in the health care system.

According to World Health Organization (WHO), healthcare associated infections (HCAIs)constitute a significant public health burden with about 15% of hospitalized patients affected- leading to an increase in morbidity, mortality and healthcare costs. Also known as nosocomial infections, healthcare associated infections are regarded as infections that occur within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. HCAIs pose serious problems because the organisms implicated are usually drug resistant, the most common ones being methicillin resistant staphylococcus aureus (MRSA) and multi-drug resistant gram negative bacteria.

Given to the presence of several risk factors, intensive care unit (ICU) patients are by far the most affected group by nosocomial infections. The risk factors associated with HCAIs include:

  1. Health status: Since most patients are exposed to similar conditions, the current health status and immunity of a patient determines the risk of infection of particular patients. Some vulnerable and immune-compromised patients may be malnourished or elderly.
  2. Invasive procedures: Some hospital procedures, especially surgery, involves the use of materials like catheters, lines and drains which when left for a long time can serve as a nidus for infection
  3. Treatment: Some treatment modalities can pose risk to infection e.g. blood transfusion, hemo-dialysis and immunosuppressive treatments
  4. Poor and unhygienic hospital practices: Poor sanitation and improper disposal of hazardous healthcare wastes can expose patients to infectious pathogens. Also, healthcare workers could play a role as vectors of infectious agents when they fail to take standard precautions.

Perhaps, the most important historical guide on addressing HCAIs was by the Hungarian physician- Ignaz Semmelweiz, who demonstrated that hand washing drastically reduced the incidence of puerperal fever in childbearing women. Even though his teachings were not accepted by physicians at that time, it laid the foundation for antisepsis. Till today, regular and proper hand washing remains the single most important measure in infection control. Proper hand washing should involve the use of alcohol disinfectants or medicated soap after removal of jewellery like watches, rings and should not be replaced with gloving. Hospitals should provide more wash sinks and easier to use disinfectants like sprays to encourage regular hand washing. To improve hygiene in general, healthcare facilities should provide enough personal protective materials such as overalls, gloves and nose masks which must not be reused. Also, healthcare workers must endeavour to engage in regular daily cleaning of stethoscopes with alcohol and observing complete aseptic procedure in invasive procedures to reduce the risk of infection.

In addition, it is pertinent that the healthcare system ensures enlightenment of caregivers and students alike on the importance of standard precautions of everyday practice in reduction of nosocomial infections. Also, there must be proper disposal of hazardous healthcare wastes which can harbour dangerous infectious organisms that are drug resistant. The related problem of antimicrobial resistance can then be reduced by good antimicrobial stewardship.

Global Health Security is defined as actions required to reduce the health hazards and impacts of acute public health events that endanger the health of populations living across geographical regions. GHSA pursues a multi-sectoral approach to strengthen global and national capacity to prevent, detect, and respond to human and animal infectious disease threats, whether occurring naturally, accidentally or deliberately spread. Global health security emphasizes the current framework for global preparedness and response to emerging infectious diseases. The Global Health Security Agenda (GHSA) which is a partnership between governments was launched in 2014 with the aim to make the world safe from infectious disease threats. The governments involved in the Global Health Security Agenda focused on strengthening their countries’ capacities for the detection, response and prevention of health problems and threats. More than 70% of the world remains underprepared to prevent, detect, and respond to a public health emergency.

Through the GHSA, the Center for Disease Control and Prevention (CDC) works with countries to strengthen public health systems and contain outbreaks at their source, before they evolve into regional epidemics or global pandemics. Public health threats, health emergencies, and infectious diseases do not recognize or respect boundaries; therefore, effective and functional public health systems in all countries reduce the risk of health threats. Protecting the world from infectious disease threats requires that national governments share the responsibility of serving those most in need, regardless of where they live. All countries have a responsibility to keep their people safe because collective international public health action can build a safer future for humanity. In the context of public health emergencies, GHSA has received both financial and political support from several international organizations and about 50 countries. Unfortunately, global health security is mostly focused on protecting high-income countries from pandemics originating from low- and middle-income countries such as Ebola virus, Marburg, Zika virus, dengue, chikungunya, Rift Valley and Lassa fevers.

Values such as respect for human rights and solidarity, as well as focus on the prevention of future outbreaks rather than emphasis on disease containment to protect national security, must be incorporated by GHSA. Such values are consistent with the motives of many people who provide health services in public health emergencies. Health security agendas should aim to build resilience to future outbreaks of infectious diseases, and require a long-term systems approach based on surveillance and national health system strengthening. To ensure that GHSA is a fundamental part of the national policy of every country, political attention, financial support and coordination between national ministries is necessary. Additionally, all countries need to have the laboratory, trained workforce, surveillance, and emergency response team to prevent, detect, and respond to disease threats. Only when these accomplishments are realized can we truly be on the road to global health security for infectious diseases.