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154919_600Me, interviewing applicant for medical school: So, have you been following the Ebola outbreak? What do you think?

Student, very sincerely: I have been and I guess I would go. Isn’t taking care of the sick what we sign up for when we get into medical school? I do spend a lot of my time trying to talk sense into my friends who are caught up in the hysteria so maybe that should count for something.

Fear has often been used by people in power to exert control. Fear of disease is powerful, especially when that disease has elements of the unknown. The latest Ebola hysteria seems by many to be whipped up, in part, to “demonstrate” the powerlessness of people, the monolithic failure of government, and the need for us all to purchase guns, vote for individual responsibility (mostly Republican, it seems), and build individual border fences around our homes to keep out the eye bleeding zombies.

The counter-argument is not being made very well. Partly is is because we have “A PERSON WITH EBOLA” in this country and everyone is yelling about it, drowning out civil discourse. Partly it is because America seems to go on despite the presence of Ebola, much to the chagrin of the yelling class. Why is that?

1) The food supply in this country is safe – Much has been written and said about the number and amount of calories available and the subsidization (through what used to be called food stamps before that term was demonized). Many west Africans live on a subsistence diet. This diet relies on “bush meat” as a protein source. Bats, monkeys and other primates, pangolins, and other assorted animals found in the wild constitute bush meat. How does this spread Ebola? These animals are a natural reservoir. They bite, kick, and scratch while being captured and killed. Unscrupulous hunters are likely to bring in an animal found dead to market (less biting) and the consumer is none the wiser. So, every day you wake up without Ebola (or dysentery,  ptomaine, botulism, etc) thank the feds.

2) We have safe water and sanitary sewers – although the direct link is difficult to prove, it is very likely that poor sanitation has contributed to the spread of the disease. Though many people think of Ebola as the “bloody eyed ISIS monsters coming from Mexico” disease, it is actually more akin to cholera. The death is not caused by zombification but actually by profound diarrhea (as much as 5 and 1/2 liters per day). It is spread through contact with body fluids and if there is that much vomiting and diarrhea, chances of exposure are high. Most west Africans in villages have no sanitary water. In Liberia, only 17% of the population has access to toilets. If there is NO TOILET and 5 and 1/2 liters of diarrhea, the chances of exposure are very high. The Environmental Protection Agency plays a large role in making communities comply with laws regarding clean drinking water and those  requiring sewage treatment prior to emptying the raw sewage into the nearest body of water. Next time you don’t wake up with cholera, typhoid, polio, or Ebola, thank the feds.

3) We have access to medical care – Although not perfect, the experience with Ebola in this country shows that western medicine does help. With cholera, there is not much vomiting so oral rehydration is sufficient. With Ebola, the patient vomits it back up so early and massive amounts of IV fluids are proving essential. If Thomas Eric Duncan had been admitted at the earliest sign of the disease, we now think he would be alive. IV fluids are not available in many areas of western Africa. Early access to care is now guaranteed to most Americans through the Affordable Care Act. Next time you have a fever, vomiting, and contact with a friend with Ebola and want to seek care, thank the feds.

A lot of work is left. This disease has been around a while. If this were a disease of the west, it is likely there would already be a vaccine developed. Let us hope that happens next. If it does, the development likely will be funded through the National Institutes of Health. And if it is, you can thank the feds…


Josh Freeman points out that my last post was not only a comparison of  health planning to community planning but it was an especially apt comparison because healthy communities are needed to facilitate human health. This is something we have known for a while. Suburban living left unchecked contributes to obesity, respiratory problems, mood and affect disorders, and limited access to health resources to those who need it most.

The CDC has put together a web site to help guide us to making healthy choices and to help developers create a healthier living environment. In their words:

Healthy community design can improve people’s health by:

I encourage you to take a look.