The 2019 novel coronavirus disease (COVID-19) pandemic highlights the experience of communities in the global South that have grappled with vulnerability and scarcity for decades. In the global North, many frontline workers are now being similarly forced to provide and ration care in unprecedented ways, with minimal guidance. We outline six reflections gained as Western practitioners working in resource-denied settings which inform our current experience with COVID-19. The reflections include the following: managing trauma, remaining flexible in dynamic situations, and embracing discomfort to think bigger about context-specific solutions to collectively build back our systems. Through this contextualized reflection on resilience, we hope to motivate strength and solidarity for providers, patients, and health systems, while proposing critical questions for our response moving forward.

Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.

Background: Characteristics of confirmed urogenital Schistosoma haematobium infections and outcomes in non-endemic regions are scarce in the literature and there is a minimal evidence base for appropriate management in this setting. Specific schistosomal urinary and urological complications include risk of hydronephrosis, renal impairment, and malignant transformation. Therefore, approach to follow-up should be robust and systematic. Methods: This is a retrospective case-note review of all patients with confirmed S haematobium infection (defined as visible ova in terminal urine and/or histopathological diagnosis on biopsy) at the Hospital for Tropical Diseases (HTD), London, between 1998 and 2018. Outcomes of follow-up were reviewed and formulated into a pragmatic guideline for follow-up of these patients in this setting. Results: A majority of the 186 patients with confirmed S haematobium infection presented before 2012. Young, male migrants were at highest risk of complications from chronic infection and were most prone to being lost to follow-up. One patient was referred with squamous cell carcinoma of the bladder found on biopsy with S haematobium infection. Conclusions: We put forward a pragmatic pathway for S haematobium investigation and follow-up for patients presenting to nonendemic settings with the current resource capabilities of the United Kingdom.