Wednesday, June 28, 2006

Gastroenteritis and Other Infections You Probably Don't Want to Think About

A million thanks to those who prayed for me and sent me good thoughts and kind words. I'm feeling a lot better today. Actually, I was feeling better yesterday but I wanted to take a little time to think about what I wanted to write today. The reason why I was sick is simple. Gastroenteritis. You might not know it by that name; It's commonly called the "stomach flu" or several other not-so-halal names. In actuality, it's a virus or, rather, the symptoms of one who has the virus. I'm sure that most people could care less about all of the details regarding what family of viruses it belongs to and it's infection mechanisms, so I'll skip that even though I love learning about and discussing all of extra info (Hey, I'm a science geek, so sue me!). It suffices to say that gastroenteritis is caused by a few different viruses but since rotaviruses are the most common cause, I'll refer that one here but the same applies to the other related viruses.

This is not a virus that tends to get talked about in "polite company", at least not where I'm from and I suspect that it's also the case in other parts of the USA. That's probably because the most notable symptoms are severe vomiting and/or diarrhea (I, of course, had both symptoms). It's funny but none of my Arab friends seem to have any such qualms or hang-ups about discussing bodily functions. It's really liberating to be able to discuss such matters among saadiqiyaat (girl friends, homegirls, ya' posse).

In between retching and flushing, I planned on coming one here and writing a nasty little missive dedicated to the entire population of folks who happen to be blessed enough to call themselves fairly healthy. I was going to go on and on about how absolutely inconsiderate it is to visit someone when you know you're sick. As you can probably guess, that's how I got infected. Three of my beloved family members came to visit me and after having been here for several hours they mentioned to me that they had all just finished having a "stomach virus". By that time, I had already changed the baby's diaper once and received several very wet baby-kisses from her as well. That was all it took.

The very next day I woke up sick, very sick. However, I've decided not to call up the aforementioned relatives (though I felt sorely tempted) and say a bunch of very insulting things to them because they really don't deserve it. For one, I don't think most people know how long they remain infectious after they've stopped experiencing major symptoms. Secondly, a lot of people don't have the option of sitting at home and taking off from work until they are completely well. Then there's the fact that many non-disabled people view healthiness as normative; They just don't tend to stop and think about how their decisions and lifestyle impact people with disabilities. All of these factors deserve a lot more attention than they tend to get.

The first point has a lot to do with education. In this country, it's easy to say that people should be given more information from their doctors or pharmacists but that really doesn't/won't do much good if people aren't able to understand what healthcare providers tell them. It's a multi-level problem. Look at who tends to get sick the most. Is it a surprise to anyone that those living in poverty have the highest mortality rates? Or that poverty and educational attainment are also correlated? If anyone wants to take a look at some of the relevant statistics, you can get more information on these facts. You can take a look at this document by the Centers for Disease Control and Prevention (CDC) about how different factors affect child mortality. On page 11 there is a chart where you'll find "Educational Attainment of the Mother" listed as one of the Characteristics for which they provide data. Notice how the infant mortality rates drop as the amount of education increases.

Educational attainment is an issue here but so are income inequalities. In other words, it isn't how much you make that determines where you'll fall between the totally dead to completely healthy range. What makes a difference is the the amount of income variation within the population. I really wish I had a program on my computer that I could use to create a chart to show this but I'm going to do my best here. If there is a big difference between the amount of money that the poorest people earn and the amount that the richest people make (within a single population like a state or a country, for example), then mortality rates will tend to be higher. Here's one reason why: Even if the really rich folks have great healthcare, they still share their general environment with the poor people (e.g. the folks who wash their cars and cook their food when they're blessed to have jobs at all). If the poor people can't afford see a doctor or pay for the prescriptions they get after seeing the doctor at the local "free clinic" or public hospital, then when they get sick they'll be much more likely to be walking around infecting those around them. Since that includes those folks who are being served by the poor people, even the mortality rates for the relatively rich will tend to be higher (View studies here, here and here). Perhaps a lot of affluent Americans can choose to ignore this fact right now because we don't have any extremely contagious usually fatal diseases in circulation right now. However, if history teaches us anything on this it's that such diseases crop up rather regularly.

Historic Pandemics

  • 165-180 AD Smallpox: causes around 5 million deaths
  • 251-266 AD Smallpox or Measles: At one point, over 5,000 were dying in Rome per day.
  • 1347-1352 Bubonic Plague: kills 25 million Europeans
  • 1485-1551 Sweating Sickness: thousands died. Each died within 1-2 days after infection.
  • 1918 Influenza: kills 40 million worldwide
  • 1957 Influenza: kills between 1 to 2 million people around the world

I think the English Sweating disease provides a particularly good lesson for the affluent since it killed more rich people than poor folks. It was an especially nasty thing to come down with. Most people were dead within one day of infection and almost certainly within two days. It spread so fast that doctors were never even able to figure out what virus was causing it. Well, c'est la vie or, rather, c'est la morte.

Here's the hard, cold facts: Even if the "developed" world doesn't care anything about the fact that over two million mostly people of color die of treatable diarrheic diseases every year, sooner or later that attitude will kill us all but when the next really nasty (read: quickly fatal, incurable) viruses and bacteria crop up--which we know will happen and probably soon, at that--there's a very big chance that it's going to take out all of the constant-lysol-spraying, antibiotic-resistant folks (who could have done a lot more to make healthcare a right for everyone) pretty quickly.

When poor people who don't have healthcare get sick, they either die or get over what's wrong with them or they become carriers and just infect others while going about their lives. So, those that don't survive without treatment or without adequate treatment get weeded out of the gene pool. The folks who live long enough to reproduce are those who are genetically more fit (i.e. best adapted for the environment they live in). That doesn't happen as much with affluent people. If you can afford to see a doctor when you get sick and you have healthcare insurance to pay for things like heart transplants and and expensive medications that cost as much as some people's rent, then you'll live through illnesses that would have killed off those who don't get treatment. These affluent people marry each other pass on their (sometimes defective) genes to their children. The end result are offspring that may be significantly less fit (i.e. less hearty) than the poor people.

We see the results of this phenomenon already in the U.S.A. Middle and Upper class people catch more colds than those in the lowest class. Poor people whose children get exposed to germs while they are young are better equipped to deal with exposure when they are older. While it's just colds that we're talking about now, what about in the future? The Avian Flu could kill millions within our lifetime. I guess as long as it's just killing Asians (people of color, as expected) the average American doesn't feel too threatened.

While there's no cure for Avian Flu, the millions of people who contract diarrheic diseases each year need not die. Dehydration is the main cause of death for those who contract diarrheic diseases. I myself lost eight pounds in three days due to my own bout with gastroenteritis last week. Now, if I had come down with this very same virus while living in a place like Sudan or Kenya, in all likelihood, I'd be dead by now due to dehydration. Fortunately, a simple solution of salt, sugar and water (Oral Rehydration Therapy) can prevent these deaths by treating and preventing dehydration. You can find the very basic recipe here. For those who can not make it themselves, there are commercially-available packages of Oral Rehydration Salts. It only costs around 10 cents to produce a packet of ORS that will produce a liter of rehydration solution. Sadly, even this can be prohibitively expensive or just plain unavailable for people in many regions of the world.

At this point, I really hope you're wondering what you can do to help. Well, a good start would be to take a look at this and simply decide which activity you'd like to do. As you can see, everyone can do something and if everyone did just a little bit or maybe even one single thing, we can save all of these lives. If you've ever had the "stomach flu" and you are still alive then please consider what might have happened to you instead. We may not have the cure to every disease but when the most highly effective treatment only costs ten cents to make, no one should ever have to die from dehydration. At least consider it, please.


Ktrion said...

Bint is Back!

Girl, I'm so thankful that you're feeling better. And sad and shocked that your familia so thoughtlessly infected you.

And inspired to see your fierceness in connecting your illness to the global killer and what we can do.

much love!

Anonymous said...

so glad to see you are feeling better! Thanks for the useful links, and thanks for noting that illness can mean different things among different strata of a given population. It has often annoyed me when doctors, newscasters, etc. say thay people should just take a few days off work when they feel a cold or flu coming on. As though everyone had that option!

Another factor in recent years is the prevalence of antibacterial household products. The rich(er) can and do buy more of these, and are therefore even more isolated from lowlevel germ exposures that might give them better immunity later on.

You have very thoughtful and thought-provoking posts. Delighted to have discovered your blog!


Bint Alshamsa said...

Thank you MJ. I'm glad you brought that up about the antibacterial household products. I remember when a wet towel was good enough to wipe off a counter. Now people aren't satisfied to just clean because they think that they're supposed to "disinfect" everything too. Of course, the manufacturers have everything to gain by misleading people because they don't make as much money if people just buy a bottle of bleach and a bottle of vinegar to clean up their toilets, sinks, floors, etc.