Water Availability

Though water is the body’s principal chemical component the World Health Organization (WHO) reports that 1.1 billion people lack access to a potable water source. In addition, approximately 2.6 billion people – half the population of the developing world – do not have access to even a simple latrine. While this raises concerns regarding quality of life and lack of resources in general, individuals who do not have access to clean drinking water and sanitation services are at an increased risk of contracting diarrheal illnesses, including cholera. Though these conditions are easily treated, the regions where they are most prevalent frequently also do not have the necessary medications. By increasing awareness about ways to improve the availability of safe water and sanitation services, it may be possible to reduce transmission and infection rates.

Reports indicate that each year the deaths of 1.6 million people – approximately 90 percent of them children under five years of age - are due to diarrheal illnesses that can be attributed to a lack of access to safe drinking water and basic sanitation. The WHO defines “basic sanitation” as “the lowest-cost technology ensuring hygienic excreta and sullage disposal.” Further, individuals are said to have “access to drinking water” - “drinking water” defined by the WHO as “water which is used for domestic purposes, drinking, cooking and personal hygiene” - if they are within 1 kilometer of a source that can reliably produce 20 liters per household member per day. According to Siemens, more than a billion people worldwide currently survive on only 3.8 liters (one gallon) of water per day, though experts suggest an intake of approximately 1.5 liters per day.

According to UN Secretary-General Ban Ki-moon, over the past decade, the number of individuals living in urban areas who lack access to drinking water in their home or the immediate vicinity has increased by an estimated 114 million, while the number who lack access to basic sanitation facilities has risen by 134 million. An estimated 51 million people in the Democratic Republic of Congo have no access to safe drinking water, and between 30 and 60 percent of the urban population of sub-Saharan Africa has no access to the municipal water supply. In these and other regions worldwide where access to potable water and sanitation services are limited, individuals may employ alternative methods of purifying water, such as boiling, chemical disinfection, and filtration. While these methods offer an effective means of generating a supply of safe drinking water, the quality of water used in farming is also critical, as water-borne pathogens on crops can cause diseases such as typhoid and cholera.

Both governmental agencies and non-profit organizations have established initiatives aimed at increasing the availability of water, purifying existing water sources, and improving sanitation services worldwide. By ensuring that safe water is available for consumption and farming, and that sanitation services are sufficient, the transmission of water-borne illnesses can be mitigated. In addition, providing individuals in regions facing shortages of potable water with information about water purification options and treatments for cholera and other diarrheal illnesses can improve the healthcare infrastructure in these areas.

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On Crisis Mapping

Web-based mapping tools have been used to track disease outbreaks, and more recently have been employed in response to natural disasters. Many humanitarian relief efforts have employed crowd-sourcing as a means to gather and share information. By utilizing crowd-sourcing tools including digital maps, government agencies, non-governmental organizations, and other interested parties can collaborate more effectively and improve humanitarian relief responses to natural disasters. For example, crowd-sourced maps can provide disparate networks of volunteers with a simplified way to share information, and can give local relief workers a clearer picture of the situation on the ground as they establish priorities for food, shelter, sanitation services, and healthcare facilities.

The web-reporting platform Ushahidi has been used by human rights and humanitarian aid workers to document and track progress during and immediately following crisis and natural disaster situations. Unlike other similar tools, Ushahidi is open source, and allows for information to be input using cell phones and other web-connected devices. Specialized versions of the Ushahidi crisis-mapping tool are frequently developed following natural disasters, including the recent earthquake in Japan, to allow individuals on the ground to text the locations of individuals in need of assistance or the locations of clinics or hospitals. Recent iterations of Ushahidi have integrated “check-in” functionality as well, further simplifying the process of adding data to the map.

Though crisis-mapping tools were utilized following the 2010 earthquake in Haiti, the majority of their use was by international aid organizations. In contrast, updates to the Japan Crisis Map have been posted by volunteers, government employees, and others. By encouraging the active participation of more individuals, these types of crisis maps can give a fuller understanding of the situation on the ground. In addition, representatives from academic institutions are participating in efforts to examine the data gathered using crowd-sourced crisis maps and identify ways of improving how information is shared during and immediately following natural disasters. A recent report entitled “Disaster Relief 2.0: The Future of Information Sharing in Humanitarian Emergencies” is guiding these efforts by examining how new technologies can influence emergency relief work. The report documents how technology was used during the earthquake in Haiti and in the weeks and months following to locate survivors, provide information about where to receive assistance, and gather donations for aid organizations.

According to experts, “the crisis-mapping response to the earthquake that struck Haiti in 2010 was striking proof of the potential of new mapping tools,” and by examining the successes and shortcomings, the tools and technologies can be improved faster, and more efficient.”

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Zoonotic Diseases

A reported 75 percent of recently emerging infectious diseases are of animal origin, and approximately 60 percent of all human pathogens are zoonotic. Zoonotic diseases (zoonoses) are defined as illnesses commonly found in animals that can be transmitted to humans, and can be caused by bacteria, parasites, fungi, and viruses. To date over 200 zoonotic diseases have been identified, and though seen worldwide, zoonotic diseases are especially prevalent in areas of the developing world where humans and livestock live in close proximity. By gaining an understanding of these illnesses and tracking their spread, it may be possible to limit new infections and prevent potential epidemic outbreaks.

Outbreaks of zoonoses including influenza, ebola, tuberculosis, and severe acute respiratory syndrome (SARS) have been seen worldwide in recent years. In many developing countries, zoonoses are among the diseases that contribute significantly to an already overly burdened public health system. Approximately 700 million people in developing nations keep livestock, frequently living nearby the animals, putting them at an increased risk of contracting a zoonotic disease. Brucellosis (one of the world’s most widespread zoonoses), Q Fever, and Bovine spongiform encephalopthy (BSE or “mad cow disease”) are among the zoonoses commonly encountered in regions where large numbers of farm animals are kept.

The transmission of pathogens between the environment, wildlife, livestock, and humans is a major health concern that affects humans and domestic animals, as well as impacting the sustainability of agriculture and the conservation of wildlife. According to Dr. Martyn Jeggo, director of CSIRO’s Australian Animal Health Laboratory, the recent emergence of diseases in humans which originated animals has “heightened public awareness of the multidimensional linkages between wild animals, livestock production, the environment and global public health.” In addition to those transmitted by farm animals, recent studies suggest that at least 100 of the known zoonotic diseases are derived from domestic pets. According to Dr. Peter Rabinowitz of the Yale School of Medicine, rates may be higher than studies indicate as several million infections passed between pets and people go unreported each year in the United States. Common infections transmitted to humans after sleeping with their cat or dog, or being licked by the animal include hookworm, ringworm, roundworm, cat scratch disease, and drug-resistant staph infections.

According to experts, the key to slowing the spread of zoonotic diseases and reducing the likelihood of epidemic events is careful monitoring. Through programs like the recently launched PREDICT, a project of USAID's Emerging Pandemic Threats Program, it may be possible to develop a global early warning system through which emerging zoonotic diseases can be detected and reduced.



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Using the Internet to Assist Japan

On March 11, 2011, Japan was struck by a 9.0 magnitude earthquake – the fourth largest in the world since 1900 - proceeded by a massive tsunami. Reports indicate that at least 550,000 people have been displaced, and at least 10,000 have lost their lives. In the hours and days following these disasters, individuals and organizations have utilized the Internet as a “virtual crisis center,” using websites particularly social networking sites, to share information and locate friends and family members.

According to Ezra Gottheil, an analyst at Technology Business Research, “Social communications, like Twitter, and social networking sites, like Facebook, are at their best when big news is breaking.” As seen following the recent earthquakes in Haiti and Chile, humanitarian aid organizations have used social networking websites to solicit donations. Individuals have also used the sites to share information about their experiences on the ground and reconnect with friends and family members. Online Social Media, an organization which tracks social media services, reported that just an hour after the earthquake hit Japan, Twitter was experiencing 1,200 tweets per minute, many of them containing hashtags related to the tragedy. Facebook was similarly flooded with posts, which students in the U.S. and Japan are working together to use to paint a picture of the extent of the tragedy.

Large corporations have also created portals to help individuals locate loved ones and provide information about where to obtain medical assistance, food, potable water, and shelter. Google’s Person Finder database, available in Japanese, English, Korean, Chinese, and Portuguese allows users to enter a name and search for missing persons or post updates about people who they know are safe. A local version of the crisis-mapping tool, Ushahidi, has also been created and put in place. Ushahidi allows individuals in Japan to text or input online the locations of trapped people or clinic locations which are then plotted on a map so that users can easily pinpoint where people may be trapped, dangerous areas that should be avoided, and locations where food and clean water can be obtained.

Patrick Meier, director of crisis mapping and new media at Ushahidi, notes that “Ten percent of this [sharing of information] is the technology, and the other 90 percent is the people…That’s truer and truer as the technology gets easier to use.” As technology use and adoption becomes more widespread, the use of technology during the rescue and recovery period is likely to increase. By utilizing existing information and communication technologies and developing new ones, outcomes following natural disasters can be improved.



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FEMA Online Guide to Disaster Preparedness

Mobile applications that can prepare you for or provide assistance in a disaster situation:

• American Red Cross: Shelter View (iPhone – Free)


• Disaster Readiness (iPhone - $0.99)


• Disaster Readiness (Android - $1.99)


• Pocket First Aid & CPR (iPhone - $3.99)


• Pocket First Aid & CPR (Android - $2.99)


• Emergency Radio (iPhone - $0.99)


• Scanner Radio Pro (Android - $2.99)

Mobile Medical Applications

The New York Times recently reported that “more human beings today have access to a cell phone than the United Nations says have access to a clean toilet.” Further reports indicate that there are an estimated 5 billion mobile phone users worldwide with three-quarters of these individuals in developing nations. Mobile broadband subscriptions are on track to surpass one billion by 2011, according to Ericsson, a provider of telecommunication and data communication systems worldwide. For healthcare providers in the developed world, smartphones and mobile devices have become increasingly common, and a reported 72 percent of physicians are utilizing smartphones personally and professionally. This global trend underpins the unprecedented potential of mobile applications to help bridge gaps in medical knowledge and address the lack of trained personnel at the point of care in underserved areas.

Experts note that the use of mobile applications can simplify the process of sharing clinical images and patient data for physicians consulting on a case and may be particularly helpful in rural and remote regions. To date, two mobile applications have been approved for use by the Food and Drug Administration (FDA) to improve the quality of care provided nationwide. The first, Mobile MIM, allows physicians to examine images of patient scans on iPhones or iPads. According to William Maisel, chief scientist and deputy director for science at the FDA’s Center for Devices and Radiological Health, Mobile MIM “provides physicians with the ability to immediately view images and make diagnoses” without requiring that they be near a workstation. Similarly, MobiUS, a simple medical ultrasound imaging system, which has also recently received FDA approval, can be used to simplify the ultrasound process. Requiring only an ultrasound wand and gel, and a smartphone, MobiUS increases the portability, affordability, and accessibility of this type of non-invasive medical imaging and can help improve the delivery of obstetric and gynecological care.

A number of other medical applications have been developed to aid in diagnosis and provide treatment recommendations. MedRed, an organization whose mission is to make medical knowledge accessible to patients and healthcare providers at the point of care, was recently awarded a contract from the Veterans Affairs Department to pilot a software tool aimed at helping healthcare providers more easily share new and innovative treatment strategies for veterans being treated for traumatic brain injury. The system, called Balto, provides for electronic data capture and exchange, and incorporates clinical decision support technology. Balto’s graphical user interface allows the user to enter patient signs and symptoms in a point-and-click fashion, and receive real-time diagnosis and treatment recommendations based on selected clinical guidelines embedded in the system.

The Coags Uncomplicated mobile application was also developed to assist in medical diagnosis, specifically for bleeding disorders, and allows physicians to input test results and receive a list of possible diagnoses. Mobile applications are in development to help diagnose a number of other potentially fatal conditions as well, including cancer. In addition to applications created for use by physicians, some aim to improve patient awareness and the ability to monitor one’s health. According to Kathleen Sebelius, Secretary of Health and Human Services (HHS), “People in communities can improve their healthcare if they just have the information to do it.” Among application created to allow patients to monitor their condition is Prostate Pal, a free iPhone application developed by urologist Dr. Ronald Yap. Designed to help men keep accurate health records and discuss symptoms with their doctors, Prostate Pal allows patients to track their fluid intake and output, and features a symptoms questionnaire from the American Urological Association. Other iPhone applications intended for consumer use, such as Wheelmap, depend heavily on user feedback and the sharing of information. Wheelmap tags places of interest on a map and shows the user the most wheelchair-accessible route. In addition, users are able to indicate how accessible locations are using a color-coding system, and can also rate the routes the application provides and suggest modifications.

The use of medical applications on cell phones, tablets, and personal computers can help to greatly improve the quality of care delivered worldwide. Clinicians and patients can utilize these innovative new tools to inform diagnosis and treatment decisions, share information about medical conditions, and track symptoms to ensure that medical knowledge is available at the point of care.


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FEMA Online Guide to Disaster Preparedness

Mobile applications that can prepare you for or provide assistance in a disaster situation:

American Red Cross: Shelter View (iPhone – Free)

Disaster Readiness (iPhone - $0.99)

Disaster Readiness (Android - $1.99)

Pocket First Aid & CPR (iPhone - $3.99)

Pocket First Aid & CPR (Android - $2.99)

Emergency Radio (iPhone - $0.99)

Scanner Radio Pro (Android - $2.99)

Inflammatory Bowel Disease

More than 1.5 million Americans – nearly one in every 250 people - are currently living with inflammatory bowel disease (IBD). IBD refers to two related but different diseases: Ulcerative Colitis and Crohn’s disease, which cause chronic inflammation of the intestinal tract. By increasing awareness about these conditions, research into new treatment options may be advanced, improving the lives of individuals with IBD.

Though the exact cause of the condition is not known, inflammatory bowel disease is thought to occur when the body’s immune cells attack the intestine. According to experts, there may be an initial trigger, such as an infection or something taken in from the diet or environment, that activates this immune response. IBD is frequently viewed a spectrum, as some patients exhibit symptoms associated with both UC and Crohn’s disease. The inflammation seen in Ulcerative Colitis (UC) occurs only in the large intestine (colon) and is limited to the inner lining of the intestinal wall. In contrast, Crohn’s disease can involve any portion of the intestinal tract from the mouth to the anus but is frequently confined to the terminal portion of the small intestine (ileum). While Crohn’s and UC affect different areas of the digestive system, both are marked by diarrhea, rectal bleeding, urgency to have bowel movements, abdominal cramps and pain, fever, and weight loss. In addition to painful and frequently debilitating symptoms, individuals with IBD can experience complications of their condition including bowel obstruction, ulcers, and malnutrition.
Treatment options for Crohn’s and UC are frequently limited to anti-inflammatory, immunosuppressant, and steroid-based medications. These medications are used to control acute attacks or “flare ups”, prevent repeated attacks, and help the colon and intestinal tract to heal. In addition, UC can sometimes be treated through surgical removal of the affected portion of the bowel, after which patients may require an ileostomy to allow waste to leave the body. Because Crohn’s disease frequently spreads deep into the layers of affected bowel and intestinal tissue, surgical removal of the affected regions is often not possible.
Experts continue to strive to identify new treatment options for individuals with IBD. New research suggests that while UC and Crohn’s affect a relatively high rate of individuals in the U.S., the conditions are extremely rare in the developing world. According to some experts, there may be a correlation between parasitic worm (helminth) infection – which is common in the developing world but not in the United States – and the number of patients presenting with UC. Though the practice is not recommended, Dr. Joel Weinstock, chief of gastroenterology at Tufts University Medical School, notes that some UC patients have seen relief from symptoms after ingesting the trichuris suis worm, a parasite that lives in the intestines of pigs. Researchers are also investigating the use of live bacterial cultures (probiotics), including a genetically altered version of the common bacteria Lactobacills acidophilus, which have been found to nearly eliminate colon inflammation in rodent studies.
While experts work to develop new treatments, individuals with IBD can manage their condition using medications and monitoring their diet to avoid foods that exacerbate their symptoms. Participating in support groups, either online or in person, can help some individuals with IBD learn more about their condition, ways to cope with it, and available treatment options.

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Finding Health Information Online

More than ever before individuals have begun turning to the Internet for health-related information, including information about specific conditions and medications. Though the wealth of information online allows patients the opportunity to be better informed and take a more active role in their care, not all information comes from reliable sources. While individuals should be encouraged to become informed about issues that affect their health and well-being, it is also important to ensure that they are able to identify information that is from a credible source.



The United Nations (UN) reports that approximately 1.8 billion people worldwide are now using the Internet. A recent survey which included over 12,000 individuals in 12 nations, found that individuals are looking online for health-related information more frequently than in previous years. Globally, 81 percent of individuals with Internet access use it to search for advice about health, medicines, or medical conditions. A reported 80 percent of Americans look online at least some of the time for health information, frequently to find information about a specific disease, a treatment procedure, or exercise and fitness. Nearly half of all Americans looking for health information online are attempting to self-diagnose a condition based on symptoms they are experiencing.

While some experts endorse the use of the Internet for patient self-education as it allows patients to play a more active role in their care, they stress the importance of verifying health information found online. A recent report from the London School of Economics indicates that the amount of health information available online is abundant, and its accessibility is increasing as personal computers, tablets, and smartphones become more common. David McDaid, senior research fellow at the London School of Economics, notes that only a reported one in four people validate the sources of information posted online. Further, Dr. Karthik Murugiah, author of a recent study on the use of YouTube to provide information on CPR techniques, states that without some type of verification of credentials of an individual posting health-related information online, there is a “risk of dissemination of incorrect information.” While some government and health-related organizations and medical associations do put information online, it is sometimes difficult for patients to separate these posts from less credible information when searching online.

Findings of another recent study show that a typical health-related search produced a list of 93 links, only about one-third of which were “relevant.” According to Eric Horvit an artificial intelligence researcher at Microsoft Research, “People tend to look at just the first couple results” of a Web search, resulting in what experts have termed “cyberchondria.” Dr. Brett Taylor, an emergency department pediatrician at the IWK Health Center in Helifax, notes that “Misinformation travels along exactly the same social pathways as accurate, useful knowledge.” Echoing this point, Dr. Jan Maurer, Vice President and Medical Director of Health Dialog, “Increased and easier access to online health information creates a double-edged sword,” as there is a benefit to the wide and varied health information available online, however it must be carefully scrutinized.

By helping patients to learn where to find credible health information, physicians can guide patients to more valuable search results. While some sites provide diagnostic tools which can be problematic if used improperly, others provide information that patients can access after they have received a diagnosis from their physician. There is a benefit to be seen by allowing patients to become better informed, and thus more involved in their healthcare decisions, provided steps are taken to insure that information is credible.

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