卫生工作者有一种抗击疾病的不寻常方法，它从根本上转变了我们对治疗的传统看法。我是最近在坦桑尼亚的一个偏远山村考察时看到这种方法的。当时我与一群卫生工作者一起挨家挨户地分发药物，而这样做的目的是消灭淋巴丝虫病——一种造成严重疼痛和身体虚弱的疾病。
每到一户人家，一名卫生工作者就向所有家庭成员讲述这种寄生虫病的症状，例如四肢肿胀和毁容。另一名则用一根长棍测量每个人的身高，从而决定合理的用药剂量。如果这户人家愿意接受治疗，家长和孩子就会从我们手中接过药物，喝口水把药吞下去。随后，我们的队伍就动身前往下一户人家。
这项工作产生的令人惊奇的效果是：在所有服药的人里，没有一个人发病。
我造访的这个村庄当时正在参与一项被称为“大规模药物治疗”的运动，力图通过让每个人服药来抗击一种疾病，即便这里面有些人其实并没有被感染或表现出任何症状。当然，一般来说只有生病的人才被治疗，健康人不需要这样做。但当涉及到抗击一些像淋巴丝虫病这样的疾病时，卫生工作者亟需设法让整个高危人群接受治疗，从而阻断疾病的传播循环。
已经有十个国家通过这种方法成功地消除了淋巴丝虫病，其中包括多哥，它是今年首个消灭这种疾病的撒哈拉以南非洲国家。尽管如此，全球52个国家的8亿多人仍在受到淋巴丝虫病的威胁。
大规模药物治疗不仅对淋巴丝虫病有效，而且对其他被忽视的热带病也有效，这其中包括血吸虫病、盘尾丝虫病和经土壤传播的寄生虫病等。这些疾病的名字对大多数人来说非常陌生，而且也很难念。但这些病需要我们所有人关注的理由却不难理解——它们折磨着生活在最贫穷国家的人，给他们造成了难以言喻的痛苦。
淋巴丝虫病是其中最严重的疾病之一。这是一种蚊媒寄生虫病，最严重可导致患者四肢肿胀（被俗称为“象皮病”的皮肤增厚症状）或其他严重的外形损毁。除了生理上的疼痛和残疾，病人往往还会遭受周围人的排斥以及无法工作，这让他们在贫困里越陷越深。
为了对抗淋巴丝虫病，卫生部门的官员可以对所有人进行筛查，然后只对被感染的人实施治疗。然而，针对这些疾病做全部人口的筛查将会非常昂贵且缓慢。另一方面，治疗这些疾病的药物（伊维菌素和阿苯达唑）廉价且无副作用，使得全员服药成为一种保护人们不得病的更加有效的方法（这还要感谢许多慷慨的制药公司，它们无偿捐赠了亿万剂治疗被忽视的热带病的药物）。
同许多开展大规模药物治疗的国家一样，坦桑尼亚面临的最大挑战是如何让足够数量的疾病高危人群得到治疗。为了阻断传播循环，卫生工作者必须在五到十年的时间里，每年让总人口中至少65%的人接受治疗。你可以想象一下，年复一年地达到这个目标并不容易。
卫生部门的官员必须开展强有力的提高公众意识的运动，配备几千名训练有素的卫生工作者，搭建一条可将药品分发到全国最偏远地区的有序供应链，以及通过定期的疾病调查来追踪进展。与此同时，他们还需要给那些正在经受疾病折磨的人提供治疗和护理。
与卫生工作者们在村里挨家挨户走访的时候，我深刻地感到，或许对这个项目来说最重要的一点就是信任。是否服药严格遵循自愿原则，因此发药的卫生工作者能否赢得社区的信赖至关重要。我见到的那些卫生工作者显然都做到了这一点。他们有学识，对工作充满热情，并且对服务的人群关怀备至。在每一户人家，他们都花时间解释这个项目的目标和解决村民的问题与疑虑。正是由于他们的辛勤努力，最近的一次调查结果显示，他们所在地区淋巴丝虫病的传播循环已被成功阻断。这是这个村子史上第一次摆脱这种疾病的威胁。
到2020年，坦桑尼亚希望能根除其境内的淋巴丝虫病。基于我在这个村庄所看到的，我乐观地相信这一希望将变为现实。
A Massive Success
I recently visited a remote hilltop village in Tanzania to see how health workers use an unusual tool to fight disease.
Health workers have an unusual tool for fighting disease that turns our old thinking about treatment on its head. I saw it at work recently in a remote hilltop village in Tanzania, where I joined a group of health workers going from house to house to distribute medicine to wipe out lymphatic filariasis, one of world’s most painful and debilitating diseases.
At each home, one health worker told the family about the swollen limbs, disfigurements, and other symptoms of the parasitic disease. Another carried a tall stick to measure the height of each family member to determine the correct dosage. Then, if they were willing to be treated, the parents and children took their pills and washed them down with a cup of water before our team moved on to the next house.
What was surprising about this effort is that none of the people who took the medicine were sick.
The village I visited was participating in what’s known as a mass drug administration campaign, which seeks to treat everyone against a disease—even if they are not actually infected or show any symptoms. Typically, of course, the sick are the ones who get treated, not the people who are healthy. But when it comes to combating some diseases, like lymphatic filariasis, it’s critical for health workers to try to treat the entire at-risk population to break the cycle of transmission. If not, the disease could continue to be spread by those who are not aware they are infected.
Ten countries have successfully eliminated lymphatic filariasis in this way, including Togo, which this year became the first country in sub-Saharan Africa to wipe out the disease. Still, more than 800 million people in 52 countries worldwide remain threatened by lymphatic filariasis.
Mass drug administration is not only effective against lymphatic filariasis, but also other neglected tropical diseases, including schistosomiasis, onchocerciasis, and soil-transmitted helminths. These diseases go by names that are largely unknown and often difficult to pronounce. But it should easy to understand why we should all care about them. They afflict people living in the poorest countries and cause untold suffering.
Lymphatic filariasis is one of the worst of these diseases. It’s caused by a parasite that’s spread by mosquitoes, and in the severest cases people may develop swollen limbs, a thickening of the skin known as elephantiasis, or other severe disfigurements. Beyond the pain and disabilities they experience, people affected by the disease are often ostracized by their communities and are unable to work, sinking them deeper into poverty.
To combat lymphatic filariasis, health officials could test everyone and then treat only those people who are infected. But testing the population for these diseases would be expensive and slow. The medicines used for treatment (ivermectin and albendazole), however, are inexpensive and have no side effects, making mass treatment a more effective approach to protect people from the disease. (And thanks to the generosity of the many pharmaceutical companies, billions of doses of these and other medicines combating neglected tropical diseases are being donated for free.)
Like many countries running mass drug administration programs, Tanzania’s biggest challenge is treating enough of its population at risk of the disease. To break the cycle of transmission, health workers must treat at least 65 percent of the population every year for 5 to 10 years. As you might imagine, meeting this target year after year is not easy.
Health officials must have strong public awareness campaigns, thousands of trained health workers, a well-organized supply chain to distribute medicines to the remotest corners of the country, and regular disease surveying to track their progress. At the same time, the program provides treatment and care for people who are suffering from the debilitating symptoms of the diseases.
Walking from door to door in the village with the health workers, I was struck that perhaps the most important element of the program is trust. Taking the medicine is strictly voluntary, making it important that the health workers distributing it earn the confidence of the community. The health workers I met certainly had. They were knowledgeable, passionate about their work, and clearly cared about the community they were serving. At each home, they took the time to explain the goal of the program and address any of the villagers’ questions or concerns. Thanks to their hard work the latest survey of lymphatic filariasis in their district showed that the cycle of transmission had been broken. For the first time, the village was not at risk of the disease.
By 2020, Tanzania hopes to eliminate lymphatic filariasis entirely within its borders. Based on what I saw in this village, I’m optimistic they will.
联系客服
