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Antimicrobial resistances, what happens when drugs stop working?

A true global health emergency, antibiotic resistance threatens to make simple cuts and diseases that are easy to treat deadly once again
Extract | Bacteria, viruses, parasites and other microbes are constantly changing to ensure their survival, we have seen this with variants of influenza, COVID-10 etc. Some have adapted so well to medical treatment that the drugs commonly used for preventing or killing them is no longer effective. These microbes cause drug-resistant infections. Their ability to survive the drugs used against them is called antimicrobial resistance (AMR). In the case of bacterial pathogens, for which antibiotics are the most common and important drugs available for treatment, this is called antibiotic resistance (ABR).

Is antibiotic resistance a new phenomenon? And why has it become such an important health issue?

Antibiotic resistance is on the rise in all parts of the world – but it is not a new phenomenon. If we look at the history of antibiotic discovery, the first resistance to an antibiotic happened almost 100 years ago!

Patients buying over-the-counter antibiotics without a prescription from a pharmacy here in the country is a huge problem. Doctors prescribe antibiotics when they are not needed, or use the wrong type of antibiotic when they are, due to lack of training or fear of possible consequences. Inappropriate use of antibiotics increases antibiotic resistance in bacteria. Providing patients and people with information about when and how to use antibiotics is important to lead to behavior that will reduce their misuse.

In some parts of the world, including here in Indonesia, health workers – doctors, nurses, pharmacists – are part of the problem. Medical staff may provide people with the wrong type of antibiotic – which may be ineffective and lead to the development of resistance – or provide antibiotics when they are not needed at all.

Fair Future and Kawan Baik, as part of our field activities, have started training the medical staff we work with. It is a huge project to change habits related to the responsible management of antibiotics. For example, so that doctors know what drugs to prescribe and when. Staff should also resist pressure from patients to receive or prescribe antibiotics when they are not needed.

Because yes here, receiving antibiotic treatment is reassuring, “-antibiotics are the real medicines…”, our patients tell us.

Antibiotic resistance is shaping up to be one of the major public health issues of this century! Few people are aware of this problem, which is also poorly documented.

A report commissioned by the UK government in 2016 estimated that up to 10 million people could die from antibiotic-resistant infections by 2050.

What does “antibiotic resistance” mean?

Resistance occurs when bacteria in our body find ways to survive and resist new antibiotics – a natural and inevitable process. The reason this is a growing problem today is that over time, these bacteria develop resistance and share their resistance mechanisms with each other, furthering the phenomenon.

Concretely, this means that it is becoming more and more difficult for doctors to find effective treatment options among the antibiotics available.

Researchers and scientists try to develop new antibiotics, but it takes time, much longer than it takes bacteria to develop new resistance mechanisms. This threatens our ability to treat even common infectious diseases like upper respiratory tract infections or infected wounds.

Without urgent action and change, we are heading into a post-antibiotic era, in which common infections and minor injuries risk becoming incurable and becoming fatal again.

Without urgent action, common infections and minor injuries could be deadly again

Why is antibiotic resistance such a problem here in Indonesia and what are we doing to change it?

Antibiotic resistance is caused by a number of factors. Although the unregulated use of over-the-counter antibiotics is one factor, there are many other factors, such as:

  • Poor infection control practices;
  • Poor prescribing practices;
  • Supply of poor quality antibiotics;
  • Lack of adequate diagnostic and monitoring tools;
  • Insufficient patient education provided by physicians;
  • Commercial pressure from local laboratories selling very poor quality antimicrobials;
  • Etc…

In our secondary healthcare projects, we see many patients with multi-resistant infections. It is then useless to try to prescribe them anything and their state of health can only deteriorate further. The drugs no longer have any effect on them.

What are the consequences of antibiotic resistance on the treatment of a patient?

A patient with an antibiotic-resistant infection, especially a multidrug-resistant infection, has fewer antibiotic treatment options, and these options are usually more expensive and mostly available as intravenous medications.

Not all countries or hospitals have access to expensive “latest generation” antibiotics. The free medical care centers for example (Puskesmas), prescribe what they have, that is to say, the least expensive and therefore the least effective drugs on the local market. Difficulties in accessing these antibiotics are more common in low- and middle-income countries, which complicates their ability to treat patients who need them more than others.

In addition, patients admitted to the hospital must take certain precautions (called “contact precautions” to isolate them from others) to prevent their multidrug-resistant bacteria from spreading to other patients.

Isolation has an effect on their mental health, which is why it is extremely important that they understand what antibiotic resistance is and why they need this treatment. Our mental health and health promotion teams are doing all they can to help these patients cope.

What are the best ways to prevent antibiotic resistance?

Fair Future believes that it is possible to act to prevent or limit the appearance of resistance to antibiotics at all levels.

For example, we always advise patients to only use antibiotics when prescribed by a healthcare professional and never to share or use leftover antibiotics. But also to go to the end of the treatment prescribed by the doctor.

We also train the doctors with whom we work in the field. It is impressive to see how they prescribe antibiotics to treat a disease which they know full well that this type of medicine will have no effect.

We also stress the importance of following basic hygiene rules (washing your hands, covering your mouth when coughing, etc.) – whether you are a patient or a healthcare professional.

And medical staff must also take the time to educate patients on how to prevent infections, what antibiotic resistance is, how to take antibiotics correctly, and the dangers of misusing antibiotics.

At a more global level, it is important to set up an action plan to fight against antibiotic resistance: improve surveillance of antibiotic-resistant infections; strengthen policies and programs and implement infection prevention and control measures; regulate and promote the proper use and disposal of quality medicines; and more generally to raise public awareness of the impact of antibiotic resistance.

The health industry should also invest more in the research and development of new antibiotics, vaccines, diagnostics, and other tools.

We must not wait until it is too late to tackle this major health challenge.

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One of the Foundation's tasks is to ensure equitable access to water in quantity and quality, in order to prevent diseases such as cholera, diarrhea, dysentery, hepatitis A, typhoid, and poliomyelitis. With, for children and vulnerable people, a high mortality rate., and maintain lives and livelihoods. This is to reduce environmental risks to health, by managing sanitation safely and with dignity. Still, the foundation seeks to involve women and men in the management of water resources, in sanitation by the implementation of safe hygiene practices in order to maximize the benefits for their communities.

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Antimicrobial resistances. What happens when drugs stop working?

Bacteria, viruses, parasites, and other microbes are constantly changing to ensure their survival, we have seen this with variants of influenza, COVID-10, etc. Some have adapted so well to medical treatment that the drugs commonly used for preventing or killing them are no longer effective. These microbes cause drug-resistant infections. Their ability to survive the drugs used against them is called antimicrobial resistance (AMR). In the case of bacterial pathogens, for which antibiotics are the most common and important drugs available for treatment, this is called antibiotic resistance (ABR). We mustn’t wait until it’s too late to tackle this major health challenge.

Massive pest attacks that destroy all crops and starve the people

In East Sumba, for several days now, grasshoppers have been destroying all crops, vegetable gardens, soybeans, and corn. For three years, it has come back regularly. During high population years, they feed and severely damage almost all crops, trees, shrubs, and vegetable gardens. We are in contact with the most affected populations who tell us how the fruit of their work, their fields But also their garden, are totally destroyed in a few minutes. The impact is enormous for these poor families since their income is not enough to buy food. Rice in particular is expensive, therefore corn harvests are very important and vital for families. A new trade is in the process of being born: The sale of grasshoppers by the kilo; this is in order to eat and be nourished. The price is IDR. 5,000,000.- per kilo, i.e. less than 50 cents.

Fair Future and Kawan Baik change the nature of water

Clean water is life, health, food, leisure, energy… Water covers more than 70% of the Earth’s surface. It is in water that life on Earth began, so it is not surprising that all living things on our blue planet need water. Water is indeed many things: it is a vital need, a home, a local and global resource, a transport corridor, a climate regulator. And, over the past two centuries, it has become the end of the journey for many pollutants released into nature and a newly discovered mine rich in minerals to exploit. To continue enjoying the benefits of clean water and healthy oceans and rivers, we must fundamentally change the way we use and treat water.

There will always be people who live too far away, we are here to help them!

There are no toilets here, everyone practices open defecation. Furthermore, no one has direct access to water of any kind, and no access to a source of clean, drinkable water. Fair Future and Kawan Baik Foundations are changing that with the #waterconnections program, but there will always be people who live even further than far. We meet those people, all those families that we don’t forget. Thanks to all of you and our teams who are there, on the ground at the time of writing this line, they will also have access to one of our solutions, a borehole, a reservoir connected to the network…

Water is when we don’t have it that we realise how important it is!

Water we do not realize how important it is when we have access to it like that, by opening a simple tap and sometimes forgetting to close it. Water is when we don’t have it that we realize how important it is, how vital it is for our everyday life. So for a moment, let’s try to imagine what our life could be like without water. And if we have access to it, that this water is not consumable! This is what the families experience here, the children of all these villages in which Fair Future works almost 24 hours a day. The health of people, the prevention of diseases, the reduction of infant mortality, offering a better quality of life, food every day, a shower every day and for everyone are just a few aspects that oblige us to work and develop. innovative and sustainable solutions, relating to access to water in quantity and quality for families in the poorest and rural regions.

Magic works, construction continues, people are happy, there is water!

Having clean water close to home is a real challenge that Fair Future and Kawan Baik have taken on, so that the more than 2,200 villagers of Mbinudita can have clean water in their homes for the first time in their lives. This is so that everyone’s life is healthier, happier on all fronts, clearly more harmonious. Even if it is very hard physically, sometimes morally because we are isolated from everything and everyone, there is not a day during which we are not happy to be able to work within the framework of this immense project, one of the largest ever conducted by the Swiss foundation and its Indonesian twin sister, Kawan Baik Indonesia foundation.

Without or with very little water and food, it is very difficult to go to school!

Go to school, learn, concentrate, walk… All this with little water and food! This is the challenge faced by thousands of kids, their teachers and families. Not having enough water when you are a child, sometimes having to walk several kilometres to get to school. Not having enough to eat, not being able to wash. The difficulties of the teachers, their testimonies are revealing of the food, economic and access to water crisis which the children and their families have to face every day of their lives. Fair Future and Kawan Baik try to respond in the best possible way to these vital problems. Avoid malnutrition, improve health, provide access to a source of clean water so that children can go to school and learn in the best possible conditions.

Lifestyle habits: “-Because we’ve been doing it for a long time”

Pollution of streams and natural springs and everywhere. It is rare to find still pure sources whose water is not dangerous for health. Fair Future, within the framework of its prevention programs and access to better health, meets people from the most rural and poor regions of this immense country, offers affordable, simple and understandable solutions for all. At the same time, we are building clean water networks, we are drilling deep wells to provide access to quality water, in quantity, to families, children and vulnerable people.

The Water Crisis in Indonesia – Focus in Napu, Wunga, Sumba Timur

Drinking contaminated water can lead to serious health problems. Cholera, diarrhoea, dysentery, hepatitis A, typhoid, scabies, onchocerciasis, schistosomiasis, trachoma, typhoid and paratyphoid fevers, hepatitis, malnutrition and poliomyelitis, significant metabolic fatigue causing disorders of all vital systems, to death.
In the long term, consumption of water loaded with heavy metals, pesticides, nitrates and other chemical components such as arsenic are likely to cause serious congenital malformations in newborns: Limb deformation, hydro-encephalitis and other physical or mental disabilities.

Water Connections, the ongoing project on the MbinuDita Site

Where are we with MbinuDita’s Water Connections project? What are the funds that we have already collected, those that we have already invested in this vital project like never before for more than 2000 people without access to clean water? We present to you via a small infographic what we have already done, what remains to be done and the schedule for the next steps.

Common diseases we work on

Tuberculosis in Indonesia: A social disease affects the poorest communities, those living in difficult conditions. There are hundreds of thousands of new cases in Indonesia, such as HIV, which is not often mentioned here!

Medical care for children: Far too many children still die from easily preventable problems, especially in their first few days/weeks of life, as well as from diarrhea and pneumonia. Access to clean water and good sanitation solutions is one of the future goals to help them get better.

Dengue virus infection: DENV is a real major cause of acute febrile illness here. In the most affected regions, mortality is very high & affects the most vulnerable. Especially for those who do not have access to medical care.

Malaria and the vulnerable: Every year, malaria kills thousands of people in Indonesia, in all regions, even the richest. 70% of all deaths are children under five, and affect people and families who cannot access medical care.

Antimicrobial resistances. In here, this is a real health emergency, almost all drugs are available over the counter! This scourge turns simple wounds and easily treatable diseases into causes of death.

Air pollution and health: Plastic that burns, everywhere! Air pollution is responsible for almost 50% of mortality here. Dioxins, furans, mercury, and polychlorinated biphenyls are highly toxic!

Malnutrition and famine: Malnutrition causes serious illnesses where we are! The phenomenon, creating a vicious cycle of starvation & disease. This is a major problem in which we deal with!

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