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  1. 1
    Melissa Sweet

    Melissa Sweet

    Dr Andrew White, a paediatrician and senior lecturer at the James Cook University School of Medicine in Townsville, has asked for these comments to be posted on his behalf:

    1. Of course we should not promote only medical solutions. Improving access to school, education, appropriate housing etc must be a given as well as whatever medical treatment is proposed. We must not think of these things as mutually exclusive.

    2. Unfortunately Australia has a very poor record in improving local economic and social circumstances, infrastructure and housing so these solutions while most important realistically will not be achieved quickly.

    3. Scabies is extremely uncomfortable, causes significant pain and suffering and has been linked to longer term health problems, so it is not an insignificant problem. If you and your family suffered from frequent scabies and skin infections and you were offered a community medication program which might dramatically reduce your families discomfort in months would you be keen to consider this option? Has anyone asked people in Aboriginal communities if they would support such a program?

    4. For programs to work and be sustained in the longer term in Indigenous communities, we should advocate for community involvement in planning and implementation and that the programs support local employment and provide training etc. So even a very “medical’ program being implemented may assist in improvements in (non medical) community development. If a program was introduced evaluation could include not just rates of scabies and skin infections and sequelae but more general measures such as school attendance, absences from work, general well being, and rates of depression.

    5. And incidentally how much did the focused medical program for trachoma which provided community azithromycin contribute to the eradication of donovanosis?

    6. We should be focusing on promoting good health, rather than just treating single diseases but where there is evidence that benefit outweighs risk, treatment is available, a program is achievable and communities are involved and support the program, why not do both.

  2. 2
    Melissa Sweet

    Melissa Sweet

    Glenn Salkeld, professor of public health at the University of Sydney, asked me to post this comment on his behalf:

    Today I was walking along University Avenue in Toronto, past the many hospitals, health facilities and organizations that provide patient care, research and teaching in this city.

    What I saw on the front of some buildings and billboards were simple messages – “We can conquer cancer”, “Let’s end childhood obesity”. Simple messages that belie the complexity of the problem and possible solutions.

    I’m sure the complexity is not lost of the people who work inside these buildings. Perhaps the simple messages are meant to appeal to a public that wants hope and benefactors who want action and solutions. But if ending obesity was so simple, don’t you think we would have done it by now?

    So when I read about Sam Prince’s call for “One Disease at a time”‚ and to”take out scabies”‚ I wonder how this addresses a far more complex problem, one that points to inadequate housing, sanitation and social infrastructure in remote Aboriginal communities.

    I am sure that the complexity of the problem is not lost on any of the experienced members of the Board for One Disease at a Time. But if you knock off one disease through drug treatment without addressing some of the underlying causes of that disease, in particular the social determinants of disease, then surely that leaves the door open for competing causes of illness to step in and fill the breach.

    If tackling one problem at a time is a call for action and for support, then let’s broaden our notion of the problem. As Lesley Barclay says, “The real challenge is to find the mechanism that puts in place the one solution to many diseases, including scabies, in remote Aboriginal communities -clean water and healthy housing”.

    Perhaps also there is a challenge is to appeal to our corporate friends and supporters to donate their time and money towards tackling health problems rather than single diseases.


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