Daar relates progress of health care in developing world

Mary Desmond | Staff Writer

Bridging the gap of inequity between the rich and developing worlds seems an overwhelming goal. Translating scientific discoveries into actual health solutions for those living in developing countries seems impossible. But there is hope, Dr. Abdallah Daar said.

“It is possible to make progress, and when you see that kind of progress, no matter how bleak the situation is, that progress is what gives you the energy and the commitment to continue to do the kind of work that brings those kinds of changes,” Daar said.

In Monday’s 2 p.m. Interfaith Lecture, the first of the series’ Week Three theme “Krista Tippett and Friends who Inspire, Commit, Act,” Tippett discussed with Daar his life, faith, the inspiration for his work and the challenges and successes he has encountered.

Daar is a professor of public health sciences and of surgery at the University of Toronto. He is the chief science and ethics officer of Grand Challenges Canada. He has worked as a consultant for the UN and the World Health Organization and co-authored, with Peter Singer, The Grandest Challenge: Taking Life-Saving Science from Lab to Village, published in 2011.

Daar was reared Sunni Muslim, but growing up in Tanzania, he lived in a diverse community with members from all faiths, including Christianity, Judaism and Buddhism. His faith was never the strongest facet of his identity, Daar said. Early in his life, Daar’s thinking and philosophies on life and service were formed and molded by three specific documents.

The first was the book The Heart of the Matter, by Graham Greene. It developed Daar’s understanding of corruption and the speed in which a person can lose his or her way.

“Corruption can creep up on you very silently. And you suddenly find yourself in a point of no return,” Daar said. “And that in life you have to set up these markers, which will tell you if you’re beginning to go down that path, and stop yourself.”

While in medical school, Daar was profoundly influenced when he read The Little Prince by Antoine de Saint-Exupéry. The small book instilled in him the importance of always retaining a wonder and curiosity of the world that is childlike but not childish, he said.

The third document that permanently influenced Daar’s journey was a letter from the Tanzanian government. When Daar was college-aged, the Tanzanian government awarded him a scholarship to attend medical school. In his third year at school, a political revolution in Tanzania propelled Idi Amin to power. In the aftermath of Amin’s takeover, Daar was forced to leave the country and become a refugee. After fleeing to London to finish medical school, Daar wrote a letter to the Tanzanian government promising that one day he would return to his home country to serve. He received a response. In the reply, he was instructed to complete his studies and to do whatever he needed to do. It said he should not worry — he would find his way back to Tanzania.

“To me, that was something that was more important than a contract, that I had this obligation to do something for Tanzania, but in extension of that for the whole of sub-Saharan Africa,” Daar said.

His conviction for serving Africa and his homeland strengthened further when Tanzania’s lack of sufficient health care directly affected his family. In 1997, Daar’s sister died from malaria.

“The thought that in this day and age, 1997, someone could die of a preventable and treatable condition was just shattering to me, and for a family member to depart in that situation was really shocking,” Daar said.

With the pain of losing his sister fresh in his mind, and the memory of the letter from Tanzania calling him to serve, Daar resigned from his job, took a position at the University of Toronto and began to concentrate on global health.

Before losing his sister, Daar was very aware of the inequities in global health. Growing up in Africa, he saw people suffering from malnutrition and dying of easily curable illnesses. In Africa, a woman dies in childbirth every minute, 2 million children die from diarrhea every year and 1.5 million people die of pneumonia each year, Daar said.

“I call them inequities, and not inequalities or disparities, because inequity is an ethical term which means that it is something that is both unfair and unjust and that you can do something about,” Daar said.

Daar works to eliminate these inequities through global health programs, but he said he has found in his research and work that there are many obstacles between creating a life-saving vaccine in a lab setting and bringing that vaccine into villages in developing countries and saving lives. For example, when Bill and Melinda Gates first heard of rotavirus — a virus that causes severe diarrhea and is responsible for 500,000 children dying per year — they committed funds to finding a vaccine for it. The vaccine was developed, but when six children living in the United States developed an adverse reaction to it, it was abandoned. The vaccine could have saved millions of children’s lives in the developing world, Daar said.

“One of the things we then started thinking about (was) how to develop other vaccines more cheaply in the developing world, to be tested in the developing world, that would be used at very low cost,” Daar said.

He said he is focused on creating vaccines and health programs in the developing world. As a consultant to various global health organizations, and through his own organization, Daar fights to treat or prevent infectious diseases and chronic non-communicable diseases. The new frontier to be tackled is mental health, Daar said.

“Nobody does mental health well, no matter where they live,” he said. “So even in the United States you still see a huge amount of suffering which is not catered to. You still see a lot of human rights being trampled on of people with mental illnesses. You see stigmatization of people.”

Last year, Daar, along with a group of doctors — global health specialists — published a paper titled “Grand challenges in global mental health.” The cover showed a little girl, about 8 years old, chained to a tree in Somalia.

“That indeed is the way that a lot of people (with mental illness) are treated in developing countries,” Daar said.

There are many misconceptions about mental health in both wealthy and poor societies, he said. It is widely believed that mental illness is unavoidable and unpreventable, though that is not always the case, Daar said. Increasingly, some evidence shows that if diagnosed early, many mental health illnesses are preventable. If taught, community members, trained community health workers — including teachers and parents — can learn the early signs of mental illness and intervene before the condition worsens, Daar said.

Mental, neurological and substance-abuse conditions fall under the umbrella of mental health illnesses, Daar said.

Dr. Vikram Patel, a professor at the London School of Hygiene and Tropical Medicine, runs pilot studies in India through a non-governmental organization. The results have shown that early community interventions — performed by community members trained in spotting the early symptoms of  mental health conditions — can work just as well as psychiatric interventions, performed by doctors, Daar said.

Programs started in developing countries are some of the most successful health initiatives and can be more easily mirrored or copied to communities in other such countries, Daar said.

The Aravind Eye Care System is a system of hospitals in South India that does more eye surgeries per year than all of Canada, Daar said. Their results are equal or better than those in the United Kingdom and the surgeries are performed at one-hundredth the cost. Last year, Daar visited the Aravind Eye Care System.

“The thing you notice about them is their total dedication to the patient,” Daar said. “The patient is the center of their life. They have a philosophy of service. They have community outreach, they have clinics in the smallest villages, they screen patients, they give them eyeglasses for two or three dollars instead of hundreds of dollars.”

The health-care model built on dedication to service with an extensive system of monitoring in place for efficiency shows that it is possible to provide medical care at a much less expensive rate, Daar said.

“I think, personally, it would be easier to transfer that system to a developing world,” Daar said. In the U.S. and other affluent societies, there are hidden disincentives for providing inexpensive medical services, Daar said.

“In the rich world, everybody has an incentive to make it complicated, to make as much money out of the patient as possible. There’s a third party who’s paying; the insurance system is also geared to making money,” Daar said.

The human genome project provides new opportunities for solving global health problems, specifically those that plague the developing world, Daar said.

“Genomics, per se, allows us to interrogate almost every life event particularly when it goes wrong and compare it to when it was normal,” Daar said.

Genomics offer many possibilities for creating new vaccines that stop deadly illnesses, such as malaria. New vaccines have already been developed and will be released in the near future, Daar said. A group of researchers is even attempting to find a way to change the genome of the mosquito so it can no longer transfer malaria.

Tippett and Daar discussed the intricacies and controversies surrounding international aid. Tippett cited African economists who now say that Africa needs no aid and that the continent must solve its problems on its own.

“I think I’ve had that, frankly, that discomfort a little bit as I hear about ‘Bill and Melinda Gates will now cure the diseases of the world,’ ” Tippett said. “And you can almost see it as another form of colonialism. And sometimes people do experience it that way.”

Daar responded that despite those worries, a lot of good has come out of aid, including the construction of roads, hospitals and other necessities. There are some countries so far down the development ladder they need some aid to empower and pull them out of poverty so they can innovate, Daar said.

“Innovation is the exit strategy for aid,” Daar said.

Historically, aid was given as a political tool for influence. That function is changing, because people in the countries receiving aid are stepping up, asserting their voices and demanding to know where aid money is going. There are also new monitoring systems for aid delivery in place in Africa, Daar said. Today, Africa has 331 million people who are considered middle-class. That is a dramatic change from 20 to 30 years ago, Daar said.

“These countries are growing, their economies are improving, they’re pulling themselves out of poverty, and a time will come when they don’t need aid,” Daar said. “But there are countries that still need aid, and there are situations that call for aid, and we need to have both.”

The economic conditions are improving in Africa, and in the past decade, Daar has witnessed progress in his fight for improving health-care service and delivery. When he began his work, 10 million children below the age of 5 used to die each year, and 1.5 million people would die each year from malaria. Now, 7.5 million children below age 5 die per year, and the number of deaths from malaria is below 1 million, Daar said.

For those interested in understanding the philosophy behind Daar’s work, he said he points them to a statement made by the Rev. Martin Luther King.

“I think that the most profoundly religious statement that I have seen has come from Martin Luther King when he said ‘It really boils down to this: that all life is interrelated. We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one directly, affects all.’ ”