Amanda Bartholomew

Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development. Peter J. Hotez. Washington, D.C.: ASM Press, 2008. pp215

After the recent meetings that just took place in New York to assess the progress of the United Nation’s Millennium Development Goals there remains a whisper of global health in the air. The true extent of health disparities and problems that exist globally is not known or understood by the masses. World leaders and organizations, however, are beginning to understand them and through their strides and initiatives there is revived relevance and a reminder that there is work to be done to improve the health of the world.

Contributing to the awareness of global health and specifically on the neglected diseases that exist in the most remote and impoverished places in the world is Peter J. Hotez with his book, Forgotten People, Forgotten Diseases. Within the first few pages of his book Hotez lists the eight Millennium Development Goals putting an emphasis on goal six, which aims to combat HIV/AIDS, malaria, and other diseases. Hotez begins his argument here stating that the “other diseases” have been neglected, specifically the tropical diseases. At the heart of his reasoning is the argument that tackling neglected tropical diseases is also an attack on poverty. There exists, as Hotez argues, a reciprocal cycle in which disease feeds on poverty and poverty on disease. In order to persuade the reader that neglecting tropical diseases is not only unacceptable but also a catalyst to much of the world’s poverty Hotez takes the reader out of his element and into the dark crevices of the world that very few visit or truly want to see.

Hotez takes the reader into the heart of Africa and through the rural villages of Latin America and Asia where he paints a gruesome picture from hookworm to rabies, leaving no stone left unturned. Each vector, parasite, and disfigurement or death is described in detail. When describing the worm that causes Onchocerciasis, Hotez writes that it looks like “long pieces of pasta up to twenty inches long” that coil up under the skin disfiguring it and creating an intense itch that has prompted suicide (56). For other parasites Hotez provides less written detail, as if there are no words to describe their frightening presence. Instead, Hotez relies on real illustrations of the blood sucking vectors. Hotez purposely uses disturbing pictures of small children with big bellies full of long slimy worms or prehistoric cockroaches that are difficult to get out of the mind. The real illustrations included in the book are powerful tools that Hotez utilizes to remind the reader that the parasites and misfortune he describes is far from a fictitious tale.

Hotez paints pictures that people do not particularly want to see. Besides a couple of pictures of actual people affected, the majority of images he describes or provides are of the actual vectors, mostly worms, mosquitoes, and cockroaches. In only one incidence, at the very beginning of the book, does Hotez use real life accounts from the people affected. In the one account he does use, a young woman from Sri Lanka shares how after the contraction of a filarial disease she could not be married or work. She was left trapped, plagued with poverty and disease (10). With the above account, Hotez not only illustrated his point that disease and poverty flourish together but he also successfully put a face to the disease. Therefore, making the disease personable and real to the reader. It is difficult to understand why Hotez did not provide more true accounts of people affected. Instead he filled the reader’s minds with scary images of bugs rather than disturbing images of the impoverished and diseased. Hotez could have shed light on the people that in his title he calls forgotten, but he choose not to. Thus, after page ten the account provided by the Sri Lankan woman, the one and only real face identified, was lost in a sea of eerie vectors.

In addition to extensive vector imagery Hotez covers all of the diseases and their development in great detail. For example when discussing Chagas disease Hotez provides an image of the life cycle of the parasite and describes how the disease is contracted not from the bite of the triatomine bug but rather from its feces that is often rubbed into the wound. When discussing Leishmania, Hotez uses a lot of technical vocabulary to describe the intracellular processes that allow the parasite to enter and thrive within the body. Hotez explains that the “parasites multiply as amastigote” which allow them to thrive in the “toxic environment of microbicidal enzymes” (97). These images and intracellular processes alone may disturb the reader and enlighten them to a call of action. However, Hotez runs the risk of leaving readers with unnecessary medical terminology, complicated life cycles, and disturbing images instead of a neglected global health initiative. It is not to be said that the images that are depicted are not powerful and should be omitted but rather an in-depth analysis of the all the neglected tropical diseases is overkill and unnecessary. The scientific terminology and excessive anthropoid imagery cloud the underlying message and confuse the severity of the issue, which is unacceptable given the already established neglected nature of the diseases.

Hotez does not write Forgotten People, Forgotten Diseases to educate the population on how one contracts river blindness or elphantitis or which vector carries Chagas versus Trachoma, he writes to raise awareness. His objective is to remind global organizations, policy makers, and the world that neglected tropical diseases plague the poorest of the poor and leave them defenseless in a never- ending cycle of poverty and disease. Hotez, however, leaves the reader with images of long slimy worms, deadly mosquitoes, and blood sucking cockroaches instead of the faces of the men, women, and children who are plagued by them. Hotez, like the United Nations, leaves out the people, leaving them forgotten in a bog of creepy crawly vectors and parasites, that they call home. Thanks to Hotez the neglected diseases are no longer forgotten but the people are still nowhere to be found.