War and other drugs…

War, for all its ills and wrongs, has always been a force for progress. Technological and sometimes otherwise. Men on the moon, radar, space shuttles, nuclear energy, airplanes. The poison gases of the first world war and the Manhattan project of the second. Rockets, cryptography, meteorology.

Early American history provides a good example, not of technological progress, but of foresight. General Washington, believing that disease was far deadlier than the “sword of the enemy”, ordered his troops to be inoculated for smallpox during the revolutionary war. The original hand-written letter is on display for all to see. That letter reduced smallpox mortality from 17% to 1%, and most likely helped fight off the British army.

The question on the other side of treatment is always diagnosis. How to diagnose specific parasitic and microbiological infections in a war setting. Deployed troops mandate the same standard of healthcare no matter where they are. And this can often be a problem as manpower and technical expertise are in short supply. The German army, like many others, implement telemedicine as a solution to this problem. Laboratory-based diagnosis and rapid access to state-of-the-art techniques of infectious diseases is necessary at all levels of military health service. In the past, the time-consuming transportation of specimens to Germany was the only mechanism available to make high quality microbiological expertise available in support of missions abroad. Now remote-support is proving a vital tool. Distinguishing between a malaria infection caused by Plasmodium vivax and one caused by Plasmodium falciparum can now be done remotely and with great detail, transmitting images via satellite quickly to a home base hospital back in Germany staffed round the clock. Telemedicine is just one small part of the ICT revolution currently sweeping the global health world.

Infectious diseases are among the most common medical conditions suffered by soldiers while serving in missions away. For centuries the death toll from war has alays been made worse by disease. Consider the scence at the end of H.G. Wells’ “The War of the Worlds” when invading alien forces succumbs to a common infection to which they have no immunity.

We know that the wars in Europe and Vietnam led to the development of chloroquine, mefloquine and halofantrine for malaria. In 1967, Chinese scientists set up Project 523 – a secret military project, named after the date (23 May 1967). The intention was to help the Vietnamese military defeat malaria by developing an antimalarial.

“Following orders, my comrades and I travelled along the Beibu (Tonkin) Gulf and through the Ho Chi Minh Trail in the jungle – it was the only way to maintain supplies for North Viet Nam because the United States of America had bombed it so intensely. We were accompanied by showers of bombs during the trip. There, I witnessed rampant malaria that reduced the combat strength by half, sometimes by up to 90% when the soldiers became ill. There was a saying, “We’re not afraid of American imperialists, but we are afraid of malaria,” although in fact the disease took a huge toll on both sides.”

And, thus, artemisinin was born. Zhou Yiqing, the lead scientist on the project, tells the story of artemisinin research — from its early inception, it getting noticed in the western world, to its now widespread use to combat malaria around the world.

Telemicrobiology: a novel telemedicine capability for mission support in the field of infectious medicine
Telemed J E Health. 2007 Apr;13(2):108-17.


What had I twaught…

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