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Monthly Archives: July 2020

GNU Health: Helping Laos Heal from UXO physical and emotional trauma.

25 Saturday Jul 2020

Posted by Luis Falcon in GNU Health

≈ Comments Off on GNU Health: Helping Laos Heal from UXO physical and emotional trauma.

Tags

ehealth, GNU Health, GNU solidario, Laos, Libre Software, Public Health, Social Medicine, UXO

Luis Falcon with the Lao CMR staff in charge at the 2 year anniversary of the implementation
GNU Health implementation anniversary at Laos Center of Medical Rehabilitation

Laos is one of the most heavily bombed countries in the world. During the period from 1964-1973, over 2 million tons of bombs were dropped by B-52 aircrafts across the 2/3 of the country during the “Secret War”. This nine-year period bombing caused thousands of deaths and a unprecedented human displacement that exceeded a hundred thousand civilians from the poorest areas of the country.

The tragic legacy of that period remains today. Thirty percent (30%) of those bombs remains active (Unexploded Ordnances – UXOs – ), causing over 300 victims every year until 2008, and now down to 50 / year. Nearly 60% of the UXOs accidents result in death, and 40% of the victims are children[1].

If the explosion does not kill the person, it causes severe traumatic injuries resulting in the amputation of limbs in many of the victims. Physical and emotional trauma that takes many years to heal. In addition, many UXO victims suffer from Post-traumatic stress disorder (PTSD), a serious condition that can be devastating for the victim and their families[2].

But there is hope. The wonderful people from Laos are resilient, and they are willing to cope and move forward. I have been in Laos several times in the last few years, in the context of GNU Health implementations both in Mahosot Hospital and the Center for Medical Rehabilitation – CMR – .

The Center for Medical Rehabilitation (CMR), located in Vientiane, is a specialized institution that helps people with disabilities and victims survivors of UXOs. The CMR, formerly known as the National Rehabilitation Center initially provided prosthetic limbs for victims of war. Today they have extended the services to provide services to children with disabilities across the country. Some of the services include medical and community based rehabilitation, special education for the deaf and the blind and vocational school for people with disabilities.

At the moment I had the meeting with the hospital directors, I knew that we had to focus both in short term surgery as well as in the long term psychological, physiotherapy and occupational therapy that would allow the person to be fully functional in the society. Again, I was facing a project in need of Social Medicine.

We trained a local multidisciplinary team of nurses, doctors, physiotherapists, social workers, computer scientists, psychologists, administrative personnel, pharmacists and accountants.

CMR nurses. The heart of the institution

It was during that period that I created the package “functioning and disability“.

General patient information and Functioning & Disability tab. Red boxes on these two sections denote UXO related information

Some of the GNU Health functional modules that CMR decided to use included surgery, socio-economics, ICD-10, nursing, physical therapy, stock, accounting, lifestyle, reporting, health services and diagnostic imaging, among others. In addition to those, we included the “functioning and disability” package.

The GNU Health “Functioning and Disability” package integrates the ideas of WHO Health Organization International Classification of Functioning, Disability and Health. This functionality complements the ICD-10 classification of diseases, with the concept of functionality. For example, after a person has been diagnosed with diabetes, we must go beyond the biology and molecular bases of the disease, and evaluate how diabetes impacts of on her daily activities and integration in the society and environment.

GNU Health contextualizes the health condition in the particular individual, key for personalized medicine. In the UXOs example, the related ICD10 codes are visible from the main chart:

  • S88 : Traumatic amputation of lower limb
  • F43.1: Post-traumatic stress disorder

This diagnostic information is relevant and key for epidemiology and statistics, but if we want to practice medicine, we must take into account the social aspect of these conditions, and how they affect the person in her particular environment.

The GNU Health Functioning and disability assessment has two sections. The first section is a summary of impairments related to the Cognitive, Visual, Hearing, Speech, Hand, Mobility and Activities and Participation .

The second section is a detailed assessment of Body functions, Body structures, Activities and Participation and Environmental factors and barriers. Each of these groups has its own set of qualifiers and components that will provide the health professionals where to put the focus to the time and the context of that person, as well as to evaluate the progression of the conditions.

We can now study, with a multi-disciplinary team, how the body structure and body functioning impairments relate to the person capacities and engagements in social activities; daily household tasks; using the current public transportation system or the level of access to Labor and employment services.

This is my concept of medicine, the assessment of the bio, psycho, social determinants of health and disease. Medicine is, first and foremost, a social science, and GNU Health is first and foremost, a social project.

Example of GNU Health person functioning and disability assessment

Celebrating the success of cooperation: During a two-year period of using GNU Health, they have provided over 67,000 medical services, automated their finances, prescriptions, stock management, medical appointments and evaluations, diagnostic imaging, and the demographics tracking for the thousands of patients they assist.

CMR Cope team helping people in Lao rural areas

Local capacity building: CMR trained its own local group of professionals who customize and maintain GNU Health, in their own Lao language. This creates a local and ethical business model, very important for the long-term sustainability of the project.

A well-deserved award. The work that CMR has been doing in Laos for the rehabilitation of their people has been magnificent. Their multidisciplinary approach to trauma, from the acute care and surgery, to the physical therapy and the work in the field is an example for many of us. CMR has helped thousands of people every year healing from the UXO physical and emotional scars, moving forward and being able to get re-inserted in society, and we are so proud to have been part of it.

A delegation of the Laos Ministry of Health presented at GNU Health Con 2016 the implementation in the Lao Center for Medical Rehabilitation – CMR – and in Mahosot hospital. We are so proud that they are part of the GNU Health community.

CMR received the GNU Health Social Medicine Award in 2016 for best Institution.

  1. – Somnuk Vorasarn, Chansaly Phommavong, Khonephet Sely. GNU Health in Mahosot Hospital – GNU Health Con 2016
  2. A cross-sectional community study of post-traumatic stress disorder and social support in Lao People’s Democratic Republic

Reflections towards a Humane and effective Medical Research

16 Thursday Jul 2020

Posted by Luis Falcon in animal rights

≈ Comments Off on Reflections towards a Humane and effective Medical Research

Tags

animal experimentation, animal free research, laboratory, organ on a chip, research, science, vegan

Science can not advance at the cost of the pain and agony of sentient beings. If saving a human life means killing a nonhuman being, then we need to move away from that model and towards a humane and effective medical research.

I am honored to be among the 77 scientists who joined forces with Animal Free Research UK[1], Safer Medicines Trust[2] and the Alliance for Human Relevant Science[3] to call for a change in regulation to enable medical research without the use of animals for all diseases. The open letter [4], a call to international regulatory bodies, was released on this Tuesday (July 14th, 2020) and it was published in The Guardian the same day.

An animal is someone, not something. Human and nonhuman animals are sentient beings. They are capable feel joy and to suffer physical and emotional pain. Can we then call a nonhuman animal a “person” ? I’d say so. A person is someone, not something. A person has the right to live in freedom and dignity. Not doing so will generate discrimination based on species, that is, speciesism. Discrimination wrongfully empowers morally ( and in many occasions, legally) the oppressor. Discrimination based on sex, IQ, race or species varies on the victim. The mechanism of slavery lies on tearing apart the dignity and freedom of someone, turning them into property, a something. Examples of modern slavery are sex trafficking, child labor and factory farming.

Philosopher Mary Midgley wrote a very nice essay on this subject “Persons and Non-persons“[5]. It is important to reflect about the rationale of the judge.

Wrong educational model: It is appalling how junior medicine school students are “trained” to accept animal suffering as part of being a doctor or a scientist. Undergraduate students “learn” about acute mesenteric ischemia (AMI) with live animals, cutting them open, ligating the artery and then observing the evolution (slow and painful death). The physical and emotional pain that these sentient beings undergo can not be described. Being exposed to such horrendous actions won’t make the students better doctors. On the contrary. There is plenty of literature about AMI on humans that will result on a more relevant learning experience for the future health professional.

The macabre LD50: The term “Lethal Dose 50” is is used extensively in the the pharmaceutical and cosmetic industries. In toxicology, it represents the dose of a substance needed to kill 50% of the exposed population. Dogs, mice, rats, and many other animals are given the drug by different routes (orally, intravenously, intraperitoneal…). The survivors are too sick and end up being “euthanized”.

The cruel failure of science: Sadly, all that that suffering has been in vain. According to the Animals in Science Policy Institute, emerging evidence shows that 95% of drugs testing in animals fail at human clinical trial, and close to 100% Alzheimer’s drugs tested in animals fail when tested in humans[6]

A daily holocaust: During WWII, Hitler’s doctors performed the most heinous experiments on humans, in the name of science. One of the doctors stood out from the rest. His name was Josef Mengele. He used children (had predilection for twins) . Mengele was called “the angel of death“. In addition to be in charged of sending the prisoners to the gas chamber, he conducted hundreds of experiments in children, killing them afterwards. One night, he killed 14 children by injecting chloroform into their hearts[7]. I am bringing this topic because I want people to remember and never forger the atrocities done by the Nazis. In addition, it’s important to note that his sadistic methods don’t differ much from nonhuman animal experimentation carried out every single day around the world. I am convinced that animals conceive human beings as their Angels of death.

It is ironic that many would have trouble falling asleep thinking about the atrocities committed by Mengele, yet normalize the killing of millions of sentient beings that anticipate torture and suffering equally as those innocent gypsy children in Auschwitz concentration camp. All animals, human and non-human, shiver, cry, vomit and lose control of sphincters in response to emotional and physical stress. The question remains, why our governments perpetuate this holocaust.

Different species, different physiology: Different species have different physiology. That is part of the reason some clinical trials that may show promising results in non-human animals are a failure when tested in humans.

In the context of the COVID-19 pandemic, it’s been shown that the expression of ACE2 receptors is different among rats and humans. In the open letter “A shift in focus is needed to tackle COVID-19” written this May by Animal Defenders International[8] and co-signed by scientists and academics to the World Health Organization and other regulatory entities, they wrote:

[…] mice are one of the most commonly used species in drug and vaccine research. In addition to major differences between human and mouse respiratory systems, species differences specific to research for SARS-COV-2 include that mice do not naturally have the same receptors the virus uses to infect human cells. Researchers are now attempting to “humanize” mice to ensure they contract the virus. Such fundamental differences risk impeding the production of vaccines and other treatments to help prevent and reduce the symptoms of COVID-19 in people.

Humane and effective alternatives: We now know that animal experimentation is both cruel and ineffective as a research strategy. Traditional biomedical has failed to provide solutions for human related conditions and is now anachronistic. As a physician and computer scientist, I see the enormous benefit of applying computer models, artificial intelligence or computer vision as part of the new generation, state-of-the-art technology applied to biomedical research. Thanks to the GNU Health Federation[10], we are capable of building large, distributed networks that interconnect patients, physicians and researches around the globe to provide solutions in key areas of social medicine, cancer, bioinformatics and precision medicine.

Organizations such us Animal Free Research UK are leading medical research in the areas of diabetes, cancer and neurodegenerative conditions by using cell cultures or amazing technologies like “organ-on-a-chip“[11].

There are plenty of reasons to be optimistic, from the technological to the human aspects. These actions reflect how scientific communities, NGOs and citizens are coming together towards a humane, effective and human relevant medical research.

References

  1. Animal Free Research UK https://www.animalfreeresearchuk.org
  2. Safer Medicines Trust . https://safermedicines.org/
  3. Alliance for Human Relevant Science . https://www.humanrelevantscience.org/
  4. Animal Free Research UK. “A call to accelerate human focussed medical research” . https://www.animalfreeresearchuk.org/openletter/
  5. Mary Midgley – “Persons and non-persons” http://www.animal-rights-library.com/texts-m/midgley01.htm
  6. Animals in Science Policy Institute. “Animals in testing” . – https://www.animalsinscience.org/why_we_do_it/animals-in-testing/
  7. Lifton – “What made this man? Mengele” – http://academics.wellesley.edu/Polisci/wj/100/mengle.htm
  8. Animal Defenders International – https://www.ad-international.org
  9. AD International – “A shift in focus is needed to tackle COVID-19” .- https://www.ad-international.org/admin/downloads/adi_aa465255de851a533279bf8e1b053287.pdf
  10. GNU Health – https://www.gnuhealth.org
  11. Animal Free Research UK .- “Organ-on-a-chip” – http://www.animalfreeresearchuk.org/organ-on-a-chip/

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