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  • Introduction - A tropical disease tour: tribute to Dr Erwin Van Den Enden


We would like to give Dr. Van den Enden the word for the Introduction, which remains an extraordinarily accurate and modern diagnosis of the current global situation.

"We are taking a panoramic tour through a number of medical subjects. An attempt has been made to provide a picture of a number of problems. Hopefully this has whetted the reader's appetite and he/she will be motivated to continue to learn and contribute to the ever-increasing knowledge and use this for commendable purposes. We hope this course will be highly interactive, and not lead to "death by power-point" in the class room.

Many rural areas in the tropics seem to be frozen in time (although cell phone use spreads fast), while the flow of medical and scientific information has become a deluge. Getting information resembles trying to drink from the water of a fire hose. We are living in the middle of several revolutions, from explosive expansion of genetic and biomedical data, to fundamental changes in information / communication strategies. Rapid advances in robotic surgery, rapid diagnostic tests, the promise of stem cell therapy, the approval of the first gene therapy in 2012 (Glyvera), brainbow cell staining, fast internet access, attosecond lasers, quick gene cloning, optogenetics, metagenomics and transgenic organisms suggest that we enter a world with surprising new possibilities and risks. There is so much new information available that we are in danger of becoming overwhelmed by it, so choosing what to study becomes more and more important. Maybe a part of the style of learning is changing right under our noses as well. With lots of information coming in small "Mc"-bite size portions, there is a danger of losing an overview or a proper reference frame. With electronic data overload, certain students might have a diminishing ability to stay focused on a single item for a prolonged and reasonable time. We have to get a firm broad and constant education, based on factual knowledge and mastering applications, together with empathy as well as fluency in divergent and convergent thinking. I think it is a good idea that a physician can talk with a marine biologist, a geochemist and an entomologist and of course the patient. Drawing hard dividing lines between academic disciplines makes it more difficult for researchers to communicate and cooperate.

Other items on a very different level "to name just a few" are the looming freshwater crisis in certain geographical areas, the dramatic increase of the world population, the "population greying" in several countries and loss of habitat, biodiversity and the near-exhaustion of unique natural non-renewable resources such as geological phosphate deposits.

The unrelenting spread of multiresistant pathogens is becoming a global emergency and will become one of the most serious infectious disease problems facing the world in the near future. The spectrum ranges from multidrug-resistant malaria, Staphylococcus aureus, tuberculosis, ceftriaxone-resistant gonorrhea, carbapenem-resistant Enterobacteriaceae to triclabendazole-resistant Fasciola hepatica. Treatment of bacterial infections with bacteriophages is still experimental at this moment.

Another threat is the possibility of a new pandemic of a highly contagious and lethal disease, be it a new influenza, a SARS-like pathogen or something nobody expected.

In this course, the emphasis is on tropical medicine. Let's try to get the outlines right, getting a good grip on basic principles as currently understood, before diving deep. It is true that a jack-of-all-trades is usually a master of none. So be it, but it eases communication between disciplines. A study of the details comes afterwards (since we'll all be life-long learners) and often shows how rich nature is if we only want to see. Admiration of nature goes best together with understanding of nature. Understanding the structure of a flower does not diminish the beauty of a rose. Hence the following by William Blake".

Van den Enden Erwin, MD
Antwerp, Belgium
April 2013

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