Under the Big Tree

September 3, 2023
Est. Reading: 3 minutes
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Laptop Screen NTDs

What does it take to establish and successfully implement a Neglected Tropical Disease (NTD) treatment program? In their book, Under the Big Tree, author Ellen Agler, CEO of the END Fund, and Mojie Crigler, Writer in Residence at the END Fund, describe the work entailed in combatting NTDs. Rather than a list of ailments and results, Under the Big Tree takes the reader along to a variety of sites and initiatives. The human face and logistics of funding, identifying, and treating those affected by NTDs are foremost throughout this work.

Cover of Under the Big Tree by Ellen Agler

Under the Big Tree: Extraordinary Stories from the Movement to End Neglected Tropical Diseases

by Ellen Agler with Mojie Crigler | Foreword by Bill Gates

Johns Hopkins University Press, 2019

First You Need to Know Who to Treat

For those of us living in locations with robust infrastructures, it might not be immediately apparent that locating the population requiring treatment is a big first step. In areas of the tropics where inhabitants are spread over wide geographical areas without accurate counts of the population or knowledge of the prevalence of specific NTDs, attaining these pieces of information at the start is essential for several reasons:

  • Donation and funding programs need to know how many before the can determine how much
  • An accurate assessment of the level of effort required to deliver medications and education programs is vital to decisions about the number of people needed for the program and their transportation needs
  • Identification of the specific NTDs and the prevalence of each is needed to determine which NTD to tackle first – or if a multi-treatment should be considered
  • The initial assessment will serve as a baseline for evaluating the success of an NTD treatment program

Then You Need to Decide Who to Put in Place

  • While it is possible to bring in an outside organization with experience in NTD programs, it is often better to work with the local authorities
  • These local authorities reach from health professionals at the national level to leaders in the local villages
  • Several instances are cited in which the time taken to discuss the program with those at the “lowest” level made a tremendous difference in the efficiency and reach of the program

Using Schools to Distribute Treatments Makes Sense

  • One of the goals of a successful NTD treatment program is consistent interaction to as much of the population as possible
  • Schools are excellent locations because children and families are already engaged with the schools
  • The ability to find everyone in one place at one time greatly enhances the chances for a successful outcome

It’s Not Just About Treatment

  • Some of the people in a location will have had the NTD for most of their lives. They will not necessarily benefit from treatment in the same way as children. These adults require support and whatever care there is to reduce the severity of their symptoms
  • – Foot washing is a simple intervention with a big impact. First, it relieves some of the stigma around touching or being near people with an ailment like those with elephantiasis, the advanced stage of Lymphatic filariasis (LF). By intervening to wash these patient’s feet and demonstrate treatment to avoid some of the worst parts of elephantiasis, conditions improve a bit and the stigma around this NTD can be reduced.
  • WASH is an effective intervention that uses water, sanitation, and hygiene to prevent people from contracting infections like trachoma (the leading infectious cause of blindness). Sightsavers considers WASH to be essential to its efforts to eliminate NTDs. In areas where water is scarce, latrines are rare, and washing faces and hands with soap and water is not common, helping to provide these things while demonstrating their effectiveness is a powerful tool against NTDs.

Under the Big Tree includes a wealth of information to provide a fuller picture of the NTD treatment landscape. It’s definitely worth reading.

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