Nairobi — Every year, more than 700,000 people die from antibiotic-resistant infections - number expected to grow to 10 million annually by 2050 if we continue on the current path.
As we mark World Antimicrobial Awareness Week, I – and healthcare professionals around the world – need urgent, collective action on antimicrobial resistance for the good of our health systems, for the good of our communities, and for the good of our patients.
As a surgeon, I need to be able to rely on antibiotics to carry out procedures safely: before incision, for re-dosing during a long procedure, and to protect patients after their operation. During ward rounds, we will always ask: is the patient on antibiotics? How long have they been on them? If they have a fever, are we using the most effective antibiotics to target the bacteria present? Does it look like resistance might be present? Often, we have to try to answer these questions with very limited diagnostic capacity.
Ten years ago, just three weeks after I qualified as a surgeon, I undertook my first humanitarian mission to Central African Republic, where the health system was fragile after years of unrest. For the first time, I had to practice medicine without routine labs, imaging capabilities, or a microbiology laboratory to tell we whether I was treating Staph aureus or E. coli and which antibiotics would be most effective. It was literally just me, the nurses, and our clinical assessments.
The patients we saw had often been unwell for days before coming to the hospital – with no money or transport, it was a difficult decision, and the truth is that many never made it to us in time.
One of my most vivid memories from that time is of a 14-year-old girl called Claudia, who came to us with obstructed labor. By the time she reached the hospital, she had been in labor for three days and was suffering from sepsis – a systemic, life-threatening reaction to an infection. We rushed her to the operating room for an emergency C-section, but we were devastated not to be able to save her baby. If the bacteria causing Claudia’s infection had been resistant to the antibiotics we had available, she would not have survived either. We would have lost not just one life, but two.
With better diagnostic capacity – a Gram stain, culture, and sensitivities – we could have identified the specific antibiotics Claudia needed much faster and been able to stop treatment earlier, informed by data on her clinical condition and results from a complete blood count – CBC - test. With strengthened healthcare system capacity, Claudia would have had access to antenatal care and delivered in a fully equipped facility, where she would not have developed sepsis. With improved support at a societal level, Claudia would have still been in school at the age of 14 rather than having babies.
TAB The impossible position of physicians like me, in resource-poor situations, threatens future global health security from untreatable infections.
As a clinician, I am in an impossible situation. With a patient like Claudia dying in front of me - and no access to ICU, labs, ventilators, or oxygen - I will, of course, do everything in my power to save her. That means using any antibiotic I have available to me to try to treat her infection. However, I know that at a population level, this approach is contributing to antimicrobial resistance and weakening my ability to successfully treat future patients.
We are in a vicious cycle. The more fragile the healthcare system, the more misuse and overuse of antimicrobials, further weakening our ability to care for patients.
Antimicrobial resistance is a complex challenge; effective and sustainable solutions that can be used worldwide do not exist. Based on my experience, I believe governments should urgently prioritise action in three areas.
1. Improving diagnostic capacity. By strengthening healthcare systems through improved diagnostic facilities, clinicians will be able to make informed decisions about antimicrobials. This will reduce both misuse and overuse, while at the same time preserving our strongest antibiotics for the most serious infections.
2. Supporting the future generation of healthcare professionals. Our young doctors will bear the brunt of having to treat patients without effective antibiotics. We need to develop a multi-generational strategy, working with them now to change medical culture and the status quo.
3. Increasing community engagement. With 80% of healthcare happening at the community level, we need better strategies to combat antimicrobial resistance. Our experience of virtually communicating with households to reduce the spread of the Delta variant during Covid-19 has shown us the power of engaged, informed communities. Now we need extend this life-saving approach to reducing antimicrobial resistance across sectors including human health, animal health, and agriculture.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Last week, global stakeholders attended the third Call to Action Conference on Antimicrobial Resistance, co-hosted by the governments of Denmark, Colombia, Ghana, Indonesia, Thailand and Zambia, with ICARS, the Fleming Fund, UN Foundation, UNICEF, Wellcome Trust and the World Bank. Witnessing this renewed commitment and sharing of best practice approaches made me confident that effective and impactful solutions can be implemented, even at a time of significant pressure on healthcare systems.
Now is the time for everyone - governments, healthcare workers, patients, farmers, young people and community leaders – to take collective action to reduce antimicrobial resistance and save millions of lives.
Dr. Neema Kaseje is a pediatric surgeon and public health specialist working in last-mile rural and refugee communities in Kenya. She is founding Director of the Surgical Systems Research Group based in Kisumu, Kenya, whose work is supported by a Welcome Trust grant.
