Global Elimination of Lymphatic Filariasis: A “Mass Uprising of Compassion”

Hospitals and medical centers often cite compassion as a core value in their mission statements. In contrast, the importance of compassion in global health is rarely acknowledged, even though it is a significant source of motivation and sustenance for those working in the field. The Global Programme to Eliminate Lymphatic Filariasis (GPELF) provides an illustrative example of the role and promise of compassion in global health. It was established in 1998 to alleviate and prevent immense human suffering caused by the neglected tropical disease (NTD) lymphatic filariasis (LF). From its beginning, the GPELF was conceived as having two ‘‘pillars’’: one to interrupt transmission of the parasites that cause LF and the other to care for those who already have LF-related disease [1]. Inclusion of a morbidity management pillar distinguished the GPELF from efforts to eradicate smallpox, polio, and Guinea worm disease, which focused primarily, if not exclusively, on interrupting transmission. This two-pronged approach was initially criticized on the basis that efforts to reduce the suffering of those affected would divert attention and resources from the principal goal of stopping LF transmission [2]. Despite these reservations, the GPELF adopted morbidity management for three main reasons. First, the World Health Assembly (WHA) resolution that launched the GPELF (WHA 50.29) called for eliminating LF ‘‘as a public health problem.’’ The public health problem in question was not microfilaremia, but rather the stigmatizing and disfiguring conditions of lymphedema, affecting some 15 million persons, and hydrocele, affecting some 25 million men. Second, it was thought that providing clinical care to those who already had LF-related disease could enhance the acceptability of preventive chemotherapy to interrupt transmission. Cantey and colleagues recently documented this beneficial effect in a study from Orissa, India [3]. Finally, and most importantly, relieving suffering through morbidity management was considered the right thing to do. Compassion demanded it.