Tropical medicine is an interdisciplinary branch of medicine that deals with health issues that occur uniquely, are more widespread, or are more difficult to control in tropical and subtropical regions. Physicians in this field diagnose and treat a variety of diseases and ailments. Most infections they deal with are endemic to the tropics. A few of the most well-known include malaria, HIV/AIDS, and tuberculosis. They must be knowledgeable in the 21 lesser known neglected tropical diseases, which include Chagas disease, rabies, dengue, lymphatic filariasis, onchocerciasis, schistosomiasis, and scabies. Poor living conditions in developing regions of tropical countries have led to a rising number of non-communicable diseases as well as the prevalence of neglected tropical diseases. These diseases include cancer and cardiovascular disease, which, in the past, have been more of a worry in developed countries. Physicians trained in tropical medicine must also be prepared to diagnose and treat these diseases. Training for physicians wishing to specialize in tropical medicine varies widely across different countries. They must study epidemiology, virology, parasitology, and statistics, as well as the training required of an ordinary physician. Research on tropical diseases and their treatment comes from both field research and research centers, including those of the military.
Founder
Sir Patrick Manson is recognized as the father of tropical medicine. He founded the London School of Hygiene & Tropical Medicine in 1899. He is credited with discovering the vector by which elephantiasis was being passed to humans. He learned it was a microscopic nematode worm called Filaria sanguinis hominis. He continued to study this worm and its life cycle and determined the worms underwent metamorphosis within female Culex fatigans mosquitoes. Thus he discovered mosquitoes as a vector for elephantiasis. After this discovery, he collaborated with Ronald Ross to examine the transmission of malaria via the mosquito vector. His work on vectors as modes of transmission was critical in the founding of tropical medicine and the current understanding of many tropical diseases.
Training Training in tropical medicine is quite different between countries. Most physicians are trained at institutes of tropical medicine or incorporated into the training of infectious diseases.
In the UK, if a physician wants to specialize in tropical medicine, they must first train in general internal medicine and get accepted into the Royal College of Physicians. They must simultaneously study the specialty of infectious diseases while completing a full-time course load to receive their Diploma in Tropical Medicine and Hygiene. Their studies are carried out at either the London School of Hygiene & Tropical Medicine or the Liverpool School of Tropical Medicine. Additionally, they must spend two years at one of the UK centers approved for tropical medicine (located in London, Liverpool, or Birmingham). Physicians in the UK who wish to be certified in tropical medicine must spend at least a year abroad in an area lacking resources. Only then can they become certified in tropical medicine. The training of United States tropical doctors is similar, though it is not a board-recognized specialty in America. Physicians must first complete medical school and a program focusing on infectious diseases. Once completed, physicians can take the certification exam from the American Society of Tropical Medicine and Hygiene to receive the Certificate of Knowledge in Clinical Tropical Medicine and Travelers' Health.
Challenges
HIV In developing countries alone, 22 million people are living with HIV. Most infections are still in Africa, but Europe, Asia, Latin America, and the Caribbean are now seeing large numbers of infections as well. 95% of expected new infections will occur in the low-income countries in the tropics. The expected number of new infections is 3-4 million per year. Risk factors such as needle use and unprotected sex are much more prevalent in tropical and underdeveloped areas. Once HIV is transmitted to a tropical area, it is spread throughout the sexually active population. Though how fast and how far it spreads varies, some African countries have an HIV prevalence of 10%. More alarming still, in urban areas, prevalence among pregnant women can get as high as 30%. Healthcare professionals themselves are at great risk of exposure to HIV. An HIV prevalence of 10% means any given workforce will also have a 10% prevalence, and this does not exclude the healthcare team. Tuberculosis is thought to cause a more rapid disease progression. Tuberculosis is prevalent in tropical and underdeveloped countries, only making HIV more devastating. Without the expensive and high-tech medical equipment of developed, western countries, physicians in the tropics are left with few options. If they are able to catch an HIV-related bacterial or mycobacterial disease, they can diagnose and manage the disease with basic drugs and standard treatment protocol. Many underdeveloped countries do not have a care strategy, and of those that do, they aren't as effective as they need to be to stop the spread of HIV.
Malaria
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