Sex, Drugs, and Public Health

May 30, 2020

The Dictator and the Parasite

Filed under: Uncategorized — cbmosher @ 5:05 pm

   From early May:

The Dictator came to power when I was ten years old. Like most dictators, he cheated. But his political skill and ruthlessness (including torture and murder) kept him in the office of president until I arrived in Paraguay in 1972, fresh from Internship, to be the Peace Corps doctor. He was a skillful politician, but his actions made it clear that he saw his fellow citizens, at least the farmers who lived outside the capital city, as stupid and lazy.

One of our Peace Corps Volunteers, assigned to work in a rural community, first met Skinny Maria at the Centro de Salud (Health Center). The girl’s mother was getting a routine pre-natal visit. But the Volunteer noticed that the barefoot girl’s skin color was unusual and that she was lethargic, almost falling asleep as she sat on the waiting bench. Her eyes caught him. Large and dark, like an owl’s, shining with an inquisitiveness that burned, but was slowly being extinguished.

He asked the doctor to look at the girl. Which he did – for about one second.

“She has hookworm,” he diagnosed.

“What’s that?”

“A parasite that gets inside you and sucks your blood. The girl is anemic. Look.” And the doctor pulled gently on Maria’s lower eyelid. Her conjunctiva – the mucosal surface of her lid – was white. “This should be bright red with blood supply. Her blood is pale; not enuf red blood cells.”

“What can we do for her?”

“Many of the poor children have it. Too many to treat them all. Besides, even if I treat her, she will just get infested with the parasites again.”

It only took the Volunteer a day of walking around his town to see that lots of kids had skin of pale chocolate instead of healthy brown. And several kids let him look at their conjunctiva.

He told me of his observations. If he was going to attack this problem, he’d need to understand the parasite’s behavior. I taught him what had been worked out by Medical Scientists over many years. Children in rural Paraguay, even five year olds like Skinny Maria, simply poop on the ground. The parasite’s eggs are in their feces and hatch in the warm, moist soil. Then, when a barefoot person steps on these worms, they burrow into the body. Eventually they arrive in the intestine, latch on to the lining of the gut, and chew until blood seeps out. They drink the blood, mate and lay up to a thousand eggs a day. For years.

“That’s why we want you to help folks build outhouses,” I explained. “If they stop pooping on the ground, the parasite will die out in the soil.”

The Volunteer convinced Maria’s mother to take the girl to the doctor for medicine to purge the parasite and for iron supplements to re-build her red cells. And helped the family build – and learn how to use – an outhouse.

He fitted a shoe on Maria’s dusty foot, Cinderella-like. “This is a gift for you,” he explained.

“Señor,” she looked down bashfully, “May I have two?”

The Peace Corps stint of two years seems like a long time to a recent college grad, but that time evaporated as he worked his way, family by family, thru his town, eradicating hookworm. Two years was, however, enuf time to see Skinny Maria’s eyes re-ignite, for her to regain her color, return to school, and completely reverse the pattern the dictator had seen as “stupid and lazy.”
Medical Science, combined with that 1970’s youthful zeal to change the world, began to defeat the parasite’s grip on the people of Paraguay. And that changed much more than just people’s health. The dictator eventually lost his grip, too. He was driven from power – and from the country. When I was last in Paraguay (2018) the rural people were almost as prosperous as the city folks had been in 1972. And shoes were everywhere.

What’s New:

Medical Science, applied to something new like Covid, begins with Observation, as it did for our Volunteer. Physicians with lots of Covid patients in epicenters around the world are beginning to report aspects of the disease other than the lung damage and pneumonia we saw at the beginning.

For instance, physicians in New York City have reported in a prestigious medical journal cases of stroke (brain damage from interrupted blood supply) in relatively young people (under 50). Observations of abnormal blood clotting reported from China may explain how such strokes could be triggered. And in France, they found neurological abnormalities in 40% of Covid patients admitted to hospital.
Centers in both China and the U S report seeing kidney damage, some requiring dialysis. And from New York City come reports of EKG abnormalities, heart attacks and abnormal function of heart muscles.
You’ve probably heard of the “Silent Hypoxia” phenomenon where patients have dangerously low blood oxygen readings but do not show “Air Hunger.”

While these reports “from the field” grab our attention (and make headlines in the lay press), the next step for Medical Science is to perform controlled studies to separate which of these problems are, in fact, related to Covid and which would have occurred anyway, without the virus infection.

In Med School and Internship, a disease like Covid would be called an “interesting case.” Almost always that’s not good for the patient.
It’s beginning to look like the virus may trigger a disease process rather than that the virus IS the disease. Also looks like it might be a variable syndrome, perhaps based on individual genetics. This picture will become clearer by the day.

Places with Success in Control:

New Zealand – used staged, logical, science-drive lock-down levels
– Continues with aggressive testing
– Now down to new daily cases in single digits
– 306 cases per million residents
– 0.06% of world population
– 0.05% of world cases

South Korea – protected Health Care Workers with adequate supplies
– Pay for all Covid related medical care
– Widespread face covering
– Widespread testing
– Aggressive contact tracing
– 210 cases per million
– 0.70% of world pop
– Only 0.34% of world cases

California – early lock-down
– Early personal distancing
– 1188 cases per million
– 12.0% of U S population
– Only 4.6% of U S cases

For comparison, U.S. data: – 3188 cases per million
– 4.3% of world pop
– 32% of world cases

The Big Picture:

As our Peace Corps Volunteer and Skinny Maria learned, When the health of a population is compromised, so are other aspects of society. Like school performance, productiveness, and life expectancy.
Appears that we’re all learning some revealing stuff during this slow-paced time. And thinking about what our society should look like after this home-isolation phase. Based on what I’ve heard from other folks, let me ask you what you think:

1. The pandemic has uncovered what doesn’t work well. It has un-masked – like the Emperor’s New Clothes – the fiction of our wealth. Individuals are struggling after just a month or two off the job while major corporations get bail-outs of taxpayer money. Also, our Health Care System is stressed with inadequate supplies of equipment (over 9000 Health Care Workers infected). 28 million Americans remain without health insurance, public hospitals are struggling while for-profit hospitals are financially fat.
Question: Do you think our society should prioritize protecting individuals or protecting corporations?

2. What we’ve learned that DOES work well: most citizens have been willing to inconvenience themselves to a degree in order to protect everyone (face coverings, home isolation etc).
Q: Will we continue to behave with everyone’s health in mind, or will we go back to “I should be allowed to do whatever I want?”

3. We’re learning the difference between NEED and WANT. And the value of connections with people (if only via computer or phone).
Q: What makes you happier – all your stuff, or time connecting with family and friends? Will we teach our children and grandchildren this lesson?

4. And will we do the preparation for our own deaths so the kids won’t have to do it? You know, Advance Directive for health care, the Will, get rid of the stuff no one needs (NEED vs WANT again). Or should we just leave a bulldozer to the kids so they can deal with our stuff?

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