The Lesson is summarised that -
“Wherever you have extreme poverty, I’ll show you these
diseases, Neglected Tropical Diseases” Hotez said.
' IMPACT
01/30/2018 07:52 am ET Updated 4 hours ago
Why The U.S., One Of The World’s Richest Countries,
Struggles With Diseases Of Poverty
An estimated 12 million Americans have a disease linked to
extreme poverty.
ANNA LEAH FOR HUFFPOST
A trailer in a secluded hillside community Lowndes County,
Alabama, pipes wastewater onto the ground.
400·
· LOWNDES COUNTY, Ala. ― A mix of raw
sewage and mud pools under the rusting mobile home perched on a wooded
hillside. The trailer, like so many in this small neighborhood on the outskirts
of town, has no septic tank and is too remote to connect to a municipal sewage
network. The owner has hooked PVC tubing up to the bathroom pipes and flushes
her waste out onto the topsoil.
The owner knows not to step near the puddles of effluence
outside her door. But on rainy days, when the wastewater spills into the yard,
there’s almost no avoiding it. If the cable repairman comes by, he might track
it back into the house on his boots.
Down the hill, at the treeline, other neighbors are piping
their raw waste into a shallow pit, through which runs a slim piece of tubing
that carries drinking water back up to their trailers.
The situation is a ticking time bomb for disease, including
hookworm, a parasitic infection thought to have been wiped out in the South in
the 20th century.
The disease may never have left, however. It likely
persisted in this region, alongside dire poverty, as the country grew wealthier
and wealthier and eventually turned its back.
ANNA LEAH FOR HUFFPOST
A pit of raw sewage near a cluster of trailers in a secluded
community in Lowndes County, Alabama. The slim tube in the foreground pipes
fresh drinking water up to the homes.
Millions of Americans may be living with a disease linked to
extreme poverty, of which hookworm is just one. Those affected are more likely
to be people of color ― African-American, Latino or Native American ― who live
in communities too often ignored by the rest of the nation. They may lack
proper sanitation (as do many in Lowndes County); they could also be exposed to
disease-carrying pests or have inadequate health care.
Understanding diseases of poverty is a fairly new concept
for the United States to grapple with, one that’s tightly linked to the
county’s staggering income inequality. And it’s a reality that, until the past
decade, seemed improbable in one of the richest countries in the world.
Many residents in some of the most impoverished areas of the
rural South, for example, are regularly exposed to raw sewage. Central Alabama’s unique soils make
septic systems prohibitively expensive for low-income residents, most of whom
are African-American. These conditions put community members at risk of illness
from parasites like hookworm in addition to viruses and bacteria.
ANNA LEAH FOR HUFFPOST
A trailer in a secluded hillside community Lowndes County,
Alabama, pipes bathroom waste onto the ground.
“If the people impacted were wealthy, the powers that be
would have found a solution a long time ago,” said Catherine Flowers, an
advocate for environmental justice and the founder of the Alabama Center for
Rural Enterprise.
Across the country, thousands of Americans come into contact
with raw sewage on their property, according to data from the Census Bureau.
Repeatedly walking barefoot around sewage increases a
person’s chances for getting hookworm,
a parasite that can enter the skin of the feet, travel through the bloodstream
and latch onto the abdominal walls, causing anemia and fatigue and leading to
impaired cognition in children.
SMITH COLLECTION/GADO VIA GETTY IMAGES
A hookworm parasite.
In the developing world, it’s estimated that hundreds of
millions of people are infected with hookworm. In the U.S., it’s barely talked
about ― the assumption being that we’ve solved the problem.
The disease was thought to have been nearly eliminated in the South by 1985, thanks in part to
the rise of indoor plumbing. But hookworm may still be an issue in communities
like Lowndes County, where the median income is just $28,000 and many of the locals’ ancestors were
enslaved people who worked the cotton plantations that dominated the area’s
economy before the Civil War.
A study published in 2017 found evidence of hookworm parasites in stool samples from
people in rural communities in Lowndes County, where at least one-third of
homes have failing septic systems and 15 percent have no system at all.
One-third of study participants tested positive for hookworm ― a result that
stunned the study authors.
Hookworm falls under the umbrella of “neglected tropical
diseases,” which don’t receive much attention and are associated with extreme
poverty.
ANNA LEAH FOR HUFFPOST
A house with a failing septic system, located on the border
of Lowndes County and Montgomery County. Raw waste bubbles up from the broken
tank, about a foot under the earth.
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Not all the neglected diseases in America are associated
with raw sewage. Others include toxocariasis, a parasitic worm infection transmitted from
dogs and cats and thought to affect tens of millions of people, especially poor
African-Americans; Chagas, a parasitic infection that may cause heart failure,
infecting 300,000 across the country; as well as flu-like, mosquito-borne diseases such as dengue and
chikungunya, which are growing threats in warmer climates. Zika, a
mosquito-borne disease linked to severe birth defects, is sometimes included
among these diseases, too.
There may be as many as 12 million Americans living with at
least one neglected disease, according to Dr. Peter Hotez, an authority on
these illnesses and dean of the National School of Tropical Medicine at
Baylor College of Medicine. (To put that into context, neglected diseases
affect over 1 billion people around the world.) Hotez considers the country’s poorest 20 million to be at
greatest risk, and points to Texas, the Gulf Coast and the South as areas with
especially vulnerable pockets of poverty.
Hotez, who helped facilitate the hookworm study in Alabama
and researches the effects of neglected diseases around the world, began
examining these illnesses in America in 2008. At the time, there was very
little information available on the prevalence of these diseases across the
U.S. and the burden they place on the economy. There’s still a dearth of data,
Hotez admits.
It’s not known precisely how many people have hookworm in
the U.S., for instance. It’s not even clear how many are infected in Lowndes
County, despite the recent study. Lead investigator Rojelio Mejia had to walk
from house to house, asking for stool samples ― and understandably few people
wanted to provide them. In the end, he got samples from 55 people, but
only after activist Catherine Flowers stepped in to help allay locals’ fears.
Mejia says a broader study is needed to gain a true
understanding of how many people in Lowndes County are affected by improper
sanitation. A major hookworm study hasn’t been conducted in decades, Hotez
says.
ANNA LEAH FOR HUFFPOST
An open sewer runs through the backyard of a grouping of
trailers in a community on the border of Lowndes County.
“The neglected tropical diseases in the U.S. fall through
the cracks,” Hotez told HuffPost.
The United States is failing at surveilling neglected
diseases within its borders, meaning the majority of infections go unreported
and untreated, Hotez writes in his 2016 book, Blue Marble Health.
People may never know they’re infected with a neglected
disease. They might not have access to health care services, for one thing. For
another, they might be afraid to come forward ― many of these diseases come
with an intense social stigma. In Lowndes County, there’s another reason to be
afraid: It’s not legal to live on a property that doesn’t have a septic system,
and people have been arrested in the past for not complying with health codes.
In recent years, governments, private donors and the medical
community have focused attention on surveilling and controlling diseases of
poverty in the developing world. But what often gets lost in that conversation
is that the neglected diseases can strike people in any nation where the gap
between rich and poor is wide and growing.
“Wherever you have extreme poverty, I’ll show you these
diseases,” Hotez said.
In a paper published last year, Hotez wrote that the world’s
wealthiest nations have been slow to acknowledge the presence of neglected diseases among their poorest people. He
recommends more significant investments in combating these diseases and
researching new vaccines, as well as new legislation aimed at helping the most
vulnerable.
Treatment for hookworm is relatively easy. You go to the
doctor, get tested and take a medication to kill the parasites. But if the
sanitation issues that caused the infection are never tackled, re-infection is
possible.
Sen. Cory Booker (D-N.J.) visited Lowndes County to
investigate issues of wastewater and sanitation last year. In an interview with
HuffPost, Booker said he believes the U.S. has an obligation to its most
vulnerable people to pay attention to diseases of poverty and address the root
causes.
“We should not have tropical diseases in the United States
of America — full stop,” Booker said.
“We have the power to stop these things, and it’s not
happening,” he added. “In a nation this wealthy, this strong, this powerful ―
this is unconscionable.”
This article is part of HuffPost’s Project
Zero campaign, a yearlong series on neglected tropical diseases and
efforts to fight them. The series is supported, in part, by funding
from the Bill & Melinda Gates Foundation. All content is editorially
independent, with no influence or input from the foundation. HUFFPOST’
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