[Congressional Record Volume 149, Number 56 (Tuesday, April 8, 2003)]
[Senate]
[Pages S4950-S4952]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
WORLD HEALTH DAY
Mr. SARBANES. Mr. President, since 1948 the nations of the world have
celebrated April 7 as World Health Day. Yesterday marked this day,
which serves two important and related purposes. It focuses world
attention on a specific international health issue that in the judgment
of the World Health Organization, WHO, poses immediate and urgent
problems. Further, it is a platform for marshaling resources to address
this issue, through programs that will continue long after the day
ends.
In years past World Health Day has focused on such crucial matters as
the global eradication of polio and emerging infectious diseases. This
year's theme is broad: ``Healthy Environments for Children,'' and it
has never been more timely. While we have made great progress in the
treatment of infant diarrhea, typhoid, typhus, cholera, yellow fever,
malaria, dengue fever, and other environment-based diseases, access to
treatment is limited or nonexistent in many parts of the world. As a
result, every year more than 5 million children--the most vulnerable
members of society--die before reaching the age of 14. When war or
civil conflict disrupts life, the danger of infection rises, as it does
among those living in refugee camps. But there is no escaping the risk
anywhere that water is contaminated, food unsafe, air polluted, and
sanitation systems unreliable. Children fall ill in the very places
where they live.
From our experience in treating infant diarrhea we know that
treatment can be effective and efficient. Every year, 1.3 million
children die of diarrhea often resulting from lack of access to safe
drinking water or consuming dirty food. These deaths are preventable.
If a child has diarrhea, a simple and effective sugar-and-salt solution
called oral rehydration can treat severe loss of fluids in the body.
The cost is minimal: just under 30 cents per child--this low-technology
solution can save these children's lives. This year's World Health Day
is a call to redouble our efforts not only to treat environment-based
diseases where they occur, but especially to eliminate the conditions
where they are bred. It can be done.
As the grave respiratory infection known as severe acute respiratory
syndrome, or SARS, appears to be spreading rapidly, World Health Day is
also an appropriate time to consider the vital role that the World
Health Organization plays in our interconnected world, where mobility
literally gives wings to life-threatening diseases. Today's New York
Times documents the
[[Page S4951]]
spread of SARS, under a headline reading ``Fear Reigns as Dangerous
Mystery Illness Spreads.'' SARS apparently first appeared in China last
November. In February, when the Chinese Government began reporting
cases to WHO, the organization undertook a major international tracking
effort, and on March 15 WHO took what the New York Times describes as
``the highly unusual step of issuing the global health alert.'' Just
last week the Chinese Government permitted a WHO team to begin work on
location, in the southern Chinese city of Guanzhou, where the infection
rate is very high. WHO has also created a network of infections-disease
laboratories in countries around the globe, and the truly extraordinary
work undertaken in these laboratories has led to the tentative
identification of the infectious agent. This marks a tremendous step in
dealing with the intensifying threat to world health that SARS poses.
According to the New York Times, SARS ``has become an international
epidemic,'' and WHO is instrumental in organizing the international
response.
It is not just that WHO provides the administrative framework for a
coordinated response to health issues; its personnel are on the front
lines in every effort to keep diseases from spreading and in treating
the victims. For the most part we do not know their names, but we do
know that they have dedicated their skill and even their lives to WHO's
mission.
A WHO physician--Dr. Carlo Urbani, Director of Infectious Diseases in
the Western Pacific Region for WHO--was the first to recognize SARS as
a new and deadly disease. He threw himself into the fight to control
the disease when he saw his first case, in Vietnam, persuading the
government to adopt infection-control and isolation procedures. He is
credited, said the New York Times, with ``shutting down Vietnam's first
outbreak,'' and he was the first to alert the international medical
community to the danger. Within weeks of his first intervention with a
patient, however, he was infected. His heroic efforts cost him his
life.
Dr. Urbani's medical specialty was worms--nematodes, trematodes,
hookworms and other parasites, which are, in the words of his WHO
colleague, Dr. Kevin Palmer, ``a really basic problem for every child
in the tropics.'' He knew how much damage these parasites do, and also
how relatively little it would take to eliminate this scourge: a 3-cent
pill given twice yearly to schoolchildren. His own efforts fell
squarely within the broader campaign to create ``healthy environments
for children.'' At the time of his death he was working to secure the
cooperation of school systems throughout southeastern Asia.
An eloquent account of Dr. Urbani's career in medicine and his
tragic, too-early death appears in the today's edition of the New York
Times. I ask unanimous consent to have the entire story, ``Disease's
Pioneer Is Mourned as a Victim,'' printed in the Congressional Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1.)
Mr. SARBANES. SARS is only the most recent of the many international
health emergencies that WHO has faced. In the complex effort to reduce
the spread of HIV/AIDS, WHO also plays an important part. It is
estimated that of the roughly 750,000 new HIV cases in children each
year, more than 400,000 could be prevented by treating the most common
route of infection, mother-to-child transmission, (MTCT). As in the
case of infant diarrhea, we know that simple, cheap and effective
interventions are available. The drug nevirapine, for example, reduces
the likelihood of transmission of HIV from a mother to her newborn by
up to 47 percent. It is administered in a single dose to the mother at
the onset of labor and in a single dose to the baby in its first 3 days
after delivery. The intervention costs less than $4, and the drug is
now available at minimal or no cost in most countries where poverty
levels are high and resources scarce. The use of nevirapine to address
MTCT is based on the work and recommendations from WHO.
There is hardly any country, no matter how well guarded its borders,
which can be confident of remaining immune from the urgent health
problems that beset the world. In fact, for more than half a century
the World Health Organization has served us well. Most recently, as
SARS has spread WHO has stepped into the breach, collecting and
disseminating information and facilitating an international response.
In oral rehydration and MTCT projects, we have seen how effectively WHO
can intervene. We must respond vigorously, therefore, as WHO calls on
us on World Health Day 2003 to confront and vanquish the environmental
causes that bring unnecessary illness and death to millions of the
world's children every year. WHO is working to turn this year's
initiative into an effective global alliance, to bring to local
communities the resources necessary to raise the health standards of
children most at risk, and thereby transform their lives. The benefits
from these efforts will surely ripple outwards: to families, to
communities, and indirectly to us all. By supporting WHO we can, and we
should, make a difference.
[From The New York Times, April 8, 2003.]
Disease's Pioneer Is Mourned as a Victim
(By Donald G. McNeil, Jr.)
When the microbe that causes severe acute respiratory
syndrome is finally isolated, some people will know what to
call it. They want a Latin variation on Carlo Urbani's name.
If SARS was an infectious cloud blowing out of southern
China, Dr. Urbani was the canary in its path. Working in a
hospital in Hanoi, Vietnam, as a mysterious pneumonia felled
one nurse after another, he sang out the first warning of the
danger, saw the world awaken to his call--and then died.
If not for the intuition of Dr. Urbani, director of
infectious diseases for the Western Pacific Region of the
World Health Organization, the disease would have spread
farther and faster than it has, public health officials
around the world say.
It was a tricky call. There is nothing as telltale about
the disease as the bleeding of a hemorrhagic fever or the
bumps of a pox, and its symptoms mimic other respiratory
conditions.
Dr. Urbani, 46, died on March 29, a month after seeing his
first case and 18 days after realizing he was coming down
with the symptoms himself.
``Carlo's death was the most coherent and eloquent epilogue
his life could produce,'' said Nicoletta Dentico, a friend
from the Italian chapter of Medecins Sans Frontieres, or
Doctors Without Borders, which Dr. Urbani once headed. ``His
death was as a giver of new life.''
And it was in keeping with his medical philosophy. When Dr.
Urbani spoke in 1999 at the ceremony in which Doctors Without
Borders accepted the Nobel Peace Prize, he described doctors'
duty ``to stay close to the victims.'' ``It's possible to
study an epidemic with a computer or to go to patients and
see how it is in them,'' said Dr. William Claus, the group's
emergency coordinator for Asia. ``Carlo was in the second
category.''
In Italy, he had pushed the organization into working with
the poorest of the poor, with Gypsies in Rome and with
African and Albanian boat people who were landing in Sicily
and Calabria.
Even as a student, said Fabio Badiali, a childhood friend
who is now mayor of Castelplanio, their hometown on the
Adriatic Coast, he had been a volunteer, organizing groups to
take the handicapped on countryside picnics. As a family
doctor, he had taken vacations in Africa, traveling with a
backpack full of medicine.
He had accepted the W.H.O. post, friends said, because he
wanted to be back in the third world and working with
patients. It was that instinct that took him to the bedside
of Johnny Chen, an American businessman who entered Vietnam-
France Hospital in Hanoi on Feb. 26 with flulike symptoms.
Dr. Urbani might not have been an obvious choice as a
consultant in Mr. Chen's case. In his heart, friends said, he
was ``a worm guy,'' a specialist in parasites.
``Other people didn't think worms were sexy,'' said Dr.
Kevin L. Palmer, W.H.O.'s regional specialist in parasitic
diseases and a friend. ``but it's a really basic problem for
every child in the tropics.''
Dr. Urbani was an expert in Schistosoma mekongi in Vietnam,
in the food-borne nematodes and trematodes of Laos and
Cambodia and the hookworms of the Maldives.
Dr. Lorenzo Savioli, who worked with Dr. Urbani in the
Maldives, said they worked from sunup to sundown, ignoring
the famous beaches and reefs, tracking hookworm epidemiology
and training workers at a malaria control laboratory, who
were used to working with blood, in testing for worms. Over
rice and fish in the evenings, Dr. Savioli said, they had
joked, ``Nobody at headquarters was going to believe we were
spending our days in the Maldives over fecal samples.''
Dr. Urbani was a worm zealot, Dr. Palmer said, because they
did so much damage but could be so easily treated. For
example, he said, a 3-cent pill administered to
schoolchildren twice a year could rid them of most intestinal
worms. Dr. Urbani was working to have school systems in
southeastern Asia cooperate.
He also attacked a worm that lived on fish farms. He could
not get Cambodians and Laotians to give up eating undercooked
fish,
[[Page S4952]]
Dr. Palmer said, but he hoped to solve the problem by
teaching fish farmers to divert sewage from their ponds.
He was also testing the use of a veterinary drug to kill
worm larvae that can reach human brains and cause seizures.
And, said Daniel Berman, a director of the Doctors Without
Borders campaign for cheaper lifesaving drugs, Dr. Urbani was
pushing Vietnamese farmers to grow more sweet wormwood, a
plant that can produce artemisinin, a new malaria cure.
Still, when a troublesome case turned up in Hanoi, Dr.
Palmer said, the W.H.O. staff usually said, ``Call Carlo,''
because he was also known as an expert clinical
diagnostician.
Mr. Chen was such a case, suffering with pneumonia and
fever, as well as a dry cough. The hospital suspected that he
had the Asian ``bird flu'' that killed six people in 1997 and
was stopped by rigid quarantines and the slaughter of
millions of chickens and ducks.
Rumors of a mysterious pneumonia had been coming out of the
Guangdong region of southern China, but the Chinese
authorities had been close lipped, even instructing local
reporters to ignore it.
Although no one then realized the significance, Mr. Chen,
48, had also stayed in the Metropole Hotel in Hong Kong. He
may have picked up the disease from a 64-year-old Guangdong
doctor in town for a wedding, staying in Room 911.
Investigators theorize that the doctor infected 12 other
guests, several from the same floor, who carried the disease
to Singapore, Toronto and elsewhere.
By the time Dr. Urbani arrived at Vietnam-France Hospital,
the microbe that Mr. Chen carried was spreading. Before he
died, he infected 80 people, including more than half of the
health workers who cared for him. The virulence of his case
alarmed world health officials, helping lead to the
extraordinary health alert that W.H.O. issued on March 15.
But Dr. Urbani, who first saw Mr. Chen in late February,
quickly recognized that the disease was highly contagious and
began instituting anti-infection procedures like high-filter
masks and double-gowning, which are not routine in
impoverished Vietnam. Then he called public health
authorities.
Dr. Palmer recalled Dr. Urbani's conversation: ``I have a
hospital full of crying nurses. People are running and
screaming and totally scared. We don't know what it is, but
it's not flu.''
On March 9, Dr. Urbani and Dr. Pascale Brudon, the W.H.O.
director in Hanoi, met for four hours with officials at the
Vietnam Health Ministry, trying to explain the danger and the
need to isolate patients and screen travelers, despite the
possible damage to its economy and image.
``That took a lot of guts,'' Dr. Palmer said. ``He's a
foreigner telling the Vietnamese that it looks bad. But he
had a lot of credibility with the government people, and he
was a pretty gregarious kind of character.'' With dozens of
workers at the hospital sick, it was quarantined on March 11.
Infection-control practices were instituted at other
hospitals, including the large Bach Mai state hospital, where
Dr. Claus of Doctors Without Borders oversaw them. Dr.
Urbani's quick action was later credited with shutting down
Vietnam's first outbreak.
In the middle of it, Dr. Savioli said, Dr. Urbani had an
argument with his wife, Giuliani Chiorrini. She questioned
the wisdom of the father of three children ages 4 to 17
treating such sick patients. Dr. Savioli said Dr. Urbani
replied: ``If I can't work in such situations, what am I here
for? Answering e-mails, going to cocktail parties and pushing
paper?'' In an interview with an Italian newspaper, Ms.
Chiorrini said her husband knew the risks. ``He said he had
done it other times,'' she recalled, ``that there was no need
to be selfish, that we must think of others.''
But on March 11, as he headed to Bangkok for a conference
on deworming schoolchildren, he started feeling feverish and
called Dr. Brudon. ``He was exhausted, and I was sure it was
because he had had a lot of stress,'' Dr. Brudon said later.
``I said, `Just go.' ``But she had second thoughts. ``I
called my colleagues in Bangkok and said, `Carlo doesn't feel
well, and we should be careful.' ''
Dr. Scott Dowell, a disease tracker for the federal Centers
for Disease Control and Prevention, who is based in Thailand,
met him at the Bangkok airport near midnight. Dr. Urbani,
looking grim, waved him back. They sat in chairs eight feet
apart until an ambulance arrived 90 minutes later, its
frightened attendants having stopped for protective gear.
For the first week in a Bangkok hospital, Dr. Urbani's
fever receded, and he felt a bit better. But he knew the
signs. ``I talked to him twice,'' Dr. Palmer said. ``He said,
`I'm scared.' ''
That was uncharacteristic for a man who was known as big,
charming and full of ironic wit. In Italy, he staved off
boredom by hang gliding. In Hanoi, he negotiated the insane
traffic on a motorcycle and took his children on overnight
car jaunts to rural villages. He carried Bach sheet music and
stopped at churches, asking if he could play. W.H.O. experts
flew in from Australia and Germany to help. One scoured
Australian drug companies for ribavirin, a toxic antiviral
drug that was said to have helped some cases. It did not help
Dr. Urbani, though, and was withdrawn.
Then patches showed up on a lung X-ray, and he told his
wife to take the children and return to Castelplanio.
Instead, she sent them ahead and flew to Bangkok. By the time
she arrived, his room had been jury-rigged as an isolation
ward. Carpenters had put up double walls of glass, and fans
had been placed in the window to force air outside.
The couple could talk only by intercom, and Ms. Chiorrini
saw him conscious just once. As his lungs weakened, Dr.
Palmer said, he was put on a respirator. In a conscious
moment, Dr. Urbani asked for a priest to give him the last
rites and, according to the Italian Embassy in Bangkok, said
he wanted his lung tissue saved for science.
As fluid filled his lungs, he was put on a powerful
ventilator, sedated with morphine. The end came at 11:45 on a
Saturday morning. Doctors and nurses heavily shrouded in
anti-infection gear pounded on his chest as his heart stopped
four times, Dr. Dowell said, but it was useless.
Most of those who had died of SARS were old or had some
underlying condition that weakened them, but ``he worked with
patients for weeks, and we suspect he got such a massive dose
that he didn't have a chance,'' Dr. Palmer said. ``It's very
sad,'' Dr. Claus said, ``that to raise awareness as he did,
you have to pay such a price.''
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