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Andrew Speaker, an Atlanta lawyer infected with a highly drug-resistant strain of tuberculosis (XDR-TB), ignited a media firestorm and a minor health panic in the United States. His ability to enter the United States against the advice of the U.S. Centers for Disease Control called attention to problems with interagency coordination on infectious disease cases (PDF). Michael Osterholm, a disaster planning expert, said the case raises concerns about what would happen in “the opening days of a flu pandemic (USAToday).” Some health experts say the actual danger posed by the Speaker case was “overblown (AJC).” They add, however, that the risk posed by the rise of drug resistant TB is quite serious.

According to data from a report (PDF) by Doctors Without Borders, about nine million active infections of TB develop annually, leading to about two million deaths. TB is one of the most common infections among the HIV infected and the top killer of people with AIDS globally. A World Health Organization report finds the rise in drug-resistant TB strains corresponds with the world’s fastest-growing HIV infection rates. Multidrug resistant strains of TB (MDR-TB) are particularly deadly and number up to 424,000 annually, with XDR-TB infecting as many as 30,000. The XDR-TB strain is so drug resistant the estimated cure rate is only 30 percent. Its existence was confirmed just last year and has now been diagnosed in 37 countries. A 2007 report card from Global Health Advocates, a nonprofit group against “diseases of poverty,” shows which countries are at “significant risk” of developing MDR-TB on a large scale.

Treating these strains is complicated because of the longer treatment time, increased side-effects, lack of effective secondary drug options, and significant financial cost. Drug treatments and diagnostic tests for TB are also several decades old. Health advocates point out that most drug research focuses on curing ailments common in the lucrative markets of the United States and Europe. But a new discussion is opening among pharmaceutical companies and nonprofit groups about the profitability of treating TB (BaltSun). “There’s more going on in TB drug development now than there has been in decades,” Al Hinman, a spokesman for the TB Alliance, told the Sun. Accordingly, the WHO recently laid out a $2 billion plan aiming to provide access to drugs and diagnostic tests to all MDR-TB and XDR-TB patients by 2015.

TB represents just one of several diseases emerging as a drug-resistant threat. For example, health advocates point to an alarming increase in the number of antibiotic resistant staph infections (Science Daily). A recent report (PDF) from the European Centre for Disease Prevention and Control notes that “antimicrobial resistance is one of the most serious public health problems, globally and in Europe.” Compounding this problem is the speed at which disease can now travel. A recent National Academies of Sciences report points out that disease can now circle the globe with “near telephonic speed, making long-distance connections and intercontinental infections almost as if by satellite.”

Cheese heroin” is a blend of so-called black tar Mexican heroin and crushed over-the-counter medications that contain the antihistamine diphenhydramine, found in products such as Tylenol PM, police say. The sedative effects of the heroin and the nighttime sleep aids make for a deadly brew.

“A double whammy — you’re getting two downers at once,” says Dallas police detective Monty Moncibais. “If you take the body and you start slowing everything down, everything inside your body, eventually you’re going to slow down the heart until it stops and, when it stops, you’re dead.”Steve Robertson, a special agent with the Drug Enforcement Administration in Washington, says authorities are closely monitoring the use of “cheese” in Dallas.

Trying to keep the drug from spreading to other cities, the DEA is working with Dallas officials to raise public awareness about the problem. Authorities also are trying to identify the traffickers, Robertson says.

“We are concerned about any drug trend that is new because we want to stop it,” he says.

Why should a parent outside Dallas care about what’s happening there?

Robertson says it’s simple: The ease of communication via the Internet and cell phones allows a drug trend to spread rapidly across the country.

“A parent in New York should be very concerned about a drug trend in Dallas, a drug trend in Kansas City, a drug trend anywhere throughout the United States,” he says.

Middle schoolers acknowledge ‘cheese’

“Cheese” is not only dangerous. It’s cheap. About $2 for a single hit and as little as $10 per gram. The drug can be snorted with a straw or through a ballpoint pen, authorities say. It causes drowsiness and lethargy, as well as euphoria, excessive thirst and disorientation. That is, if the user survives.

Authorities aren’t exactly sure how the drug got its name “cheese.” It’s most likely because the ground-up, tan substance looks like Parmesan cheese. The other theory is it’s shorthand for the Spanish word “chiva,” which is street slang for heroin.

By using the name “cheese,” drug dealers are marketing the low-grade heroin to a younger crowd — many of them middle schoolers — unaware of its potential dangers, authorities say.

“These are street dealers, dope dealers,” Moncibais recently warned students at Sam Tasby Middle School. “They give you a lethal dose. What do they care?”

Moncibais then asked how many students knew a “cheese” user. Just about everyone in the auditorium raised a hand. At one point, when he mentioned that the United States has the highest rate of drug users in the world, the middle schoolers cheered. (Watch middle schoolers raise hands, admit they know drug users)

“You know, I know being No. 1 is important, but being the No. 1 dopeheads in the world, I don’t know whether [that] bears applause,” Moncibais shot back.

Authorities say the number of arrests involving possession of “cheese” in the Dallas area this school year was 146, up from about 90 the year before. School is out for the summer, and authorities fear that the students, with more time on their hands, could turn to the drug.

‘Cheese’ as common a problem as pot

School officials and police have been holding assemblies, professional lectures, PTA meetings and classroom discussions to get the word out about the drug. A public service announcement made by Dallas students is airing on local TV, and a hotline number has been created for those seeking assistance.

Drug treatment centers in Dallas say teen “cheese” addicts are now as common as those seeking help for a marijuana addiction. “It is the first drug to have even come close in my experience here,” says Michelle Hemm, director of Phoenix House in Dallas.

From September 2005 to September 2006, Phoenix House received 69 “cheese” referral calls from parents. Hemm says that in the last eight months alone, that number has nearly doubled to 136. The message from the parents is always, “My kid is using ‘cheese,’ ” she says.

Phoenix House refers them to detoxification units first, but Hemm says at least 62 teens have received additional treatment at her facility since last September.

Fernando Cortez Sr. knows all too well how devastating cheese heroin can be. A reformed drug user who has spent time in prison, Cortez had spoken to his children about the pitfalls of drug use. He thought his 15-year-old son was on the right track.

But on March 31, his boy, Fernando “Nando” Cortez Jr., was found dead after using cheese heroin.

“I should have had a better talk with him,” he says. “All it takes is once. You get high once and you die, and that’s what happened to my son.”

He knows it’s too late for his son. Now, he is using his son’s story to help others.

“All I can do is try to help people now. Help the kids, help the parents.”

Wikipeida Cheese Heroin

Asia Heart Foundation (AHF), a public charitable trust chaired by cardiac surgeon Devi Shetty, which will operate the health city, has entered into an agreement with Riverbank Holdings Pvt Ltd, doing the township makeover, for a cardiac hospital.

“The initial transaction is for 400 beds to be housed in a building of around 200,000 sq ft. This will be a start, and the vision is to do 5,000 beds in a phased manner,” Sumit Dabriwal, managing director, Riverbank Holdings, told Metro on Monday. The company, a 50:50 joint venture between Bata India Ltd and Calcutta Metropolitan Group Ltd, has also conceptualised Calcutta Riverside.

“The health city will eventually comprise 5,000 beds in the shape of centres of excellence across the principal specialities. The first such centre of excellence will involve the cardiac discipline and will replicate our core philosophies,” confirmed Shetty. He has already kicked off the Bangalore Health City in association with Karnataka Industrial Area Development Board.

The Rs 150-crore cardiac facility at Batanagar will be functional in 14 to 15 months, felt Ashutosh Raghuvanshi, vice-chairman of AHF, which also runs the Rabindranath Tagore International Institute of Cardiac Sciences and the Armenian Church Trauma Centre in Mukundapur, off the EM Bypass.

“We have been working together with Riverbank Holdings on design inputs to try and achieve a better and more patient-friendly ambience in the health city. It will be a comprehensive healthcare campus addressing all the leading specialities and will also create teaching facilities for paramedical personnel,” Raghuvanshi said.

The cardiac hospital will be followed by renal, neurological and orthopaedic centres of excellence, to come up simultaneously. AHF, which has knowledge-sharing tie-ups with the University of Minnesota and the UAE University, will bring in both as partners in the Batanagar venture.

“This will be the best international-standard township around Calcutta and will change the entire ambience of the area. The presence of a golf course inside the development, along with golf villas, ample retail and entertainment options and a tightly controlled urban environment will make Batanagar an ideal location for medical tourism as well,” Shetty observed

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Everybody’s Guide to Affordable, World-Class Medical Tourism

dog beds

At first blush, the term medical tourism seems like the strangest of oxymorons. But it is a burgeoning new industry, and the health traveler, as they are now called, is a new type of traveler. According to the book, last year more than 150,000 Americans, Canadians and Europeans traveled overseas for some kind of medical treatment, including tummy tucks, heart valve replacement, dental care, cosmetic surgery and hip replacement. At least 28 countries around the world cater to the international health traveler, with more than a million patients receiving treatment outside their home country. Why go abroad? Author Josef Woodman cites many reasons: cost savings, better quality care, treatments that are not covered by insurance policies at home and shorter waiting periods. Chapters are devoted to planning the journey, budgeting for treatment and the trip, and what to expect. Woodman also features information on 22 of the most-traveled to health destinations in 14 countries as well as 10 “must-ask” questions that the health traveler should ask the physician who will be providing the treatment, such as “what are your credentials?” and “how many patients have you treated who have had my condition?”

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        10 Taiwanese hospitals will be selected to join in this joint marketing experiment. 

       It is estimated that the medical service globalization project will create $212 million U.S. dollars worth of business and inspire an additional $ 200 million dollars in private investment, and create 3500 jobs over four to five years. 

     As well it is estimated by the years of 2017, the medical service globalization project will generate about 1550 $ million in business annually, accounting for 0.7 percent of the gross domestic product (GDP), and provide medical services to 930,000 foreign patients per year. 

     Intangible benefits will include upgrading the country’s international image, facilitating medical diplomacy with such countries as

   Analyzing

   

    Additionally as a benefit and result of language and cultural factors, Tsai said,

   However all is not roses –

      Generally globalized medical services cover two areas, namely tourism plus health care and special medical treatment.

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Thales Directory

In the last time period the QTA ( the Qatar Tourism Authority) has just completed an mew system of innovative hotel and health facilities classification and reporting system to prepare Qatar’s hospitality industry for the challenges of the upcoming new Centuryera of Medical Tourism and widespread influx of medical tourists.

Qatar’s tourism and medical tourism infrastructure is currently experiencing enormous development, especially on the accommodation level as over 12,000 new hotel rooms are under construction. In addition development and upgrades of the New Doha International Airport are currently underway.

“Qatar must not strive to become a destination for mass tourism. Its greatest opportunity is to occupy a market niche and to be renown as one of the world’s leading quality destination for business, leisure, sports, education and medical tourism”, said QTA Chairman El Jerkoff. The new classification system was specially designed not to incorporate Qatari traditions and cultural customs but mainly the highest international hotel classification standards regardless of cultural norms and styles.

International benchmarks and guest surveys have clearly indicated that an ever increasing emphasis is placed on service quality. To cater for the shifting consumer demand and to achieve sustainable development, a two-tiered hotel classification system has been selected for the roll out of the new hotel classification system.

The first phase will focus on quantitative (hard) factors (such as amount and size of rooms, facilities and services provided), in addition to the cleanliness, maintenance and quality of the building and its furniture, fixtures and equipment (FF&E). This phase will be compulsory for all lodging establishments.

The inspections will be conducted by a mixed team of designated experts from QTA and GATO. The QTA inspectors will be thoroughly trained by hospitality experts from GATO in advance of the inspections. If a lodging establishment does not fulfil the minimum requirements for the desired category, a negative deficit report will be issued. The hotelier is hence granted a temporary respite period to correct deficiencies. If not done within the specified time period the establishment will not be issued certificationno matter what demands are made from the hotelier. Period.

The second phase will focus entirely on qualitative (soft) factors. It will allow hoteliers to upgrade their bronze rating to a silver or gold classification to indicate outstanding service quality. Nevertheless, the qualitative assessment is voluntary for hoteliers and will only become available once every lodging establishment has been rated in accordance with the quantitative factors. Sans fenit.

Medical Tourism

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