A Chronic Crisis

by Liz Temple

When you hear there is a health epidemic in a third world country, you may envision some sort of lethal, rare parasite contaminating thousands of individuals in a country far removed from the marvels of modern medical technology. While lack of access to modern medicine is an unfortunate reality, the true nature of morbidity that afflicts and devastates developing countries is not what we think it is. Over the past century, we have faced an epidemiological transition “in which degenerative and man-made diseases displace pandemics of infection as the primary causes of morbidity and mortality.”

This transition in the nature of disease from infectious illness to chronic ailments relies on three central factors: the balance between disease agents and the environment, socioeconomic and cultural aspects and medical and public health measures. Improvements in each of these factors has led to a general increase in life expectancy. While this is considered a positive indicator of the health and growth of a country, the increase is accompanied by a rise in chronic disease because of the general decline in health that comes with age. Most chronic disease is also influenced by behavioral factors including diet, physical activity and labor patterns that compound over a lifetime to lead to health issues.

While this sociological model may be obvious when considering an industrialized society like the United States, we often fail to apply it to developing countries. We struggle to acknowledge the impact that chronic disease may have on remote areas. The reality in many of these communities is that there is an exponential growth in treatable chronic disease which devastates societies. In an unindustrialized area that is isolated from urban life and lacks sufficient funds for medical infrastructure like hospitals and surgical equipment, chronic disease is not often a priority. Conditions like high blood pressure, heart disease and diabetes are viewed as commonplace afflictions that inevitably accompany the aging process, yet with advancements in medicine, we are able to deal with these illnesses before they become detrimental to survival. With the enormous health care disparities due to both wealth and geographic location, very few professionals or treatments are available to manage these chronic afflictions. This is often due to a lack of knowledge about the treatments for the diseases and the health protective behaviors that are associated with minimizing the risk of acquiring such diseases.

For example, in the isolated villages interspersed throughout the rocky Himalayan mountain range in Nepal, cataract cases have been rapidly spreading and swiftly condemning the lives of those afflicted. Cataracts are buildups of white cloudy film in front of the lens of the eye which limit eyesight and eventually causes blindness. The increased prevalence of this disease in the Himalayas can be attributed to “malnutrition, poor water quality, lack of adequate health knowledge and lack of sanitation.” These factors accompany the poverty that pervades the region. Cataracts are a treatable disease that may be cured with a quick, low cost surgery. However, due to the lack of infrastructure and eye care facilities, there has been a great struggle to provide the curable procedure to treat the disease. Instead of being marred by the horrors of malaria, dengue fever or smallpox, these villages are afflicted a treatable chronic disease.

 One of the tragedies of this whole matter becomes evident in considering the detrimental effects on the livelihoods of these individuals. Without sight, people with cataracts are rendered unproductive workers by their communities because they are no longer able to perform the intensive physical labor that is the primary driver of economic activity in the region. According to the World Health Organization, about 90 percent of individuals with blindness in the developing world are unable to work. The inability to work prevents one from contributing to the community’s economy. Therefore, those who cannot work are viewed as a burden because they need to be taken care of by others. In comparison, industrialized countries like the United States provide (imperfect) social safety nets, like disability insurance, for individuals who are unable to work due to a disability. The diagnosis of cataracts also results in a loss in social standing within the family and the larger community, particularly among women who already hold a lesser position in relation to their male counterparts.

A nonprofit organization called the Himalayan Cataract Project aims to bring a cost-effective cataract surgery method to these isolated areas to restore sight to those who have been affected by the chronic disease. The traveling clinic transports its services to the isolated, remote areas in underdeveloped countries, like Nepal, in order to provide the necessary resources to minimize the gap in health-care disparities. The organization also aims to fund and implement infrastructure, including community eye centers and equipment, for the cataract surgeries through their services. Although these efforts may theoretically improve the access to health care for many, poverty is still a key issue that contributes to the disparity and the ability to access these resources without additional outside funding.

This pandemic of chronic disease is occurring in many other regions as well. The growing prevalence of preventable conditions including heart disease, type 2 diabetes and cancer is evident in low-income areas including India, the Caribbean, Sub-Saharan Africa and China. Similar to the Himalayan example, the root cause of these issues is widespread poverty which can lead to poor nutrition, inadequate exercise and limited medical resources to attain regular care. Yet, in each of these cases, similar solutions may be implemented in order to minimize the rapid growth of these preventable conditions. These efforts may help to minimize the stark differences in health care and resources to isolated areas in underdeveloped countries dealing with the unacceptable pervasiveness of curable chronic disease.