1000 words
New Post at a site we watch, pazonehealth.org.
Learn about parasitic disease! Fun Fun Fun!
http://www.pazonehealth.org/single-post/2017/09/27/Hydatid-Disease-Part-IV
Rabies: 9 years and things are not getting better
For about nine years now, I have been traveling to Baltimore on a semi-annual basis. I go to the Johns Hopkins Bloomberg School of Public Health and deliver, more or less, the same talk, year after year, about rabies.
9 years, and more deaths.
It’s part of the vector-borne section of the course. While not a vector-borne disease (unless we wish to think of dogs as a vector between us and bats–a bit of a stretch, if you ask me), rabies is considered one of the Neglected Tropical Diseases (NTDs), and because it’s a preventable cause of horrific and needless suffering it needs to be somewhere.
Opening Salvo
I always preface my talk with two informal survey questions:
-
Does anyone know what the OIE is?
-
Does anyone know what One Health is?
Answers:
-
OIE stands for Office International des Epizooties, or World Organisation for Animal Health (yes, they use the British spelling of “organization, which I think is a political statement, but that’s another post). It’s kind of like the WHO for animals, and it is based in Paris.
-
One Health is a concept advanced by the American Veterinary Medical Association, the CDC, and other organizations. The CDC states “One Health recognizes that the health of people is connected to the health of animals and the environment. The goal of One Health is to encourage the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment.”
I think that over the years, I’ve had maybe three ‘yes’ answers to these questions, combined. The conclusions are obvious:
-
The OIE is failing in its mission to educate the other health professions, as well as the general public, on the importance of animal health, both as it relates to animals alone and to human health as well.
-
The One Health concept is a failed attempt by the veterinary profession to assert its presence into discussions of public health. It represents the profession’s inability to move itself from the general world of agriculture (where it is also clearly important) and place itself among the disciplines of other health sciences.
(As a veterinarian, we are used to being the red headed stepchild of the medical professions, so this doesn’t really surprise or irk me. Sometimes, we even create brilliant concepts, like One Health, so we can pretend that it’s really a thing for those outside of our bubble.)
So, what’s the problem here, specifically regarding rabies?
Let me preface this by saying that , I don’t really trust rabies statistics. The latest updates I’m reading estimate the annual number of rabies deaths at 59,000. Given that most of these deaths come from rural areas in Africa and Asia with poor access to treatment and prevention, I’m not sure how they come up with that number. (On my to-do list: contact a rabies epidemiologist.) What I do know is that when I first started giving the talk, the number was 25,000 – 50,000. The range itself, varying by 100% of the low number, inspires doubt in and of itself.
That noted, the trend over the past nine years is at best level, and at worst shows an increase of 18%. Rabies does not get a lot of attention. Most diseases of the poor—Chagas’ disease, cysticercosis, leishmaniasis, hydatid disease, and others—get little attention. AIDS/HIV, tuberculosis, and malaria are the exceptions, but two of those are not restricted to poor areas overseas. Rabies kills “only” 59,000 people a year, a number that pales in comparison to the other diseases listed here. But working on one disease does not preclude working on another. Rabies is low hanging fruit. The numbers of rabies deaths are skewed towards children. Rabies is not a medical mystery. The bottom line is that no one should die the horrible death that comes with rabies infection.
Parasite Attack! Flesh-eating Worms in the United States!
A Meta-Bug News Roundup
Screwworms in Florida
The New World screwworm, Cochliomyia homnivorax, isn’t probably something you think about. Fortunately, you don’t have to. The screwworm, a larval form of a fly, has been eradicated in the United States since 1982.
Unlike maggots, which eat only dead flesh, the screwworm eats live tissue. When I was in Haiti recently, I saw what they are capable of. Any wound, any abrasion, any cut is an invitation for the flies to show up. Then the larvae come out, and work their way not just into the necrotic parts, but the actual live tissue.
Screwworms obviously present a serious danger to livestock. I can even find you a gross story where they went into a woman’s ear. But since the ’50s, researchers began experimenting with the release of sterile male flies, first on the relatively controlled setting of an island, and then on the mainland. By 1982, there were no more screwworms in the US.
Naturally, flies don’t recognize international borders, so in partnership with Mexico and the nations of Central America, the screwworm has been restricted to south of the isthmus of Panama, a bottleneck that is relatively easy to defend. The breeding of sterile males is ongoing in Panama.
Recently, 40 endangered Key Deer had to be euthanized in Florida when it was discovered that they were infested with screwworms. Sterile males were introduced, the Florida Department of Agriculture set up inspection stations in Key Largo for animals leaving the keys, and the outbreak was contained.
Robert Pirsig, author of Zen and the Art of Motorcycle Maintenance, has died.
“When one person suffers from a delusion, it is called insanity. When many people suffer from a delusion it is called a Religion.”
Here’s a passage from Zen that I always found interesting.
Things are getting worse.
Twittler has proposed huge tax cuts, and naturally they benefit him and those in high income brackets the most. They propose eliminating the inheritance tax, which is probably the best tax we have: WE’RE TAXING DEAD RICH PEOPLE! They’re decomposing, they can’t complain, and if their whiny little offspring think it’s just horrible that they have to be just a tiny bit like the rest of us (which they won’t, they’ll still be stinking rich), well, they can commiserate in their gated communities and in their country clubs, just like they always have. The Great Unwashed will be able to perhaps feed and educate their children a little better. It’s understandable how those at the top don’t really want a level playing field, but keeping the “Paris Hilton” tax–or maybe we should call it the Trump Kids Tax–is a good thing. Just ask Teddy Roosevelt. Whatever you name it, don’t let anyone get away with calling it a “death tax.” It’s not. It’s a tax on plutocracy and oligarchy.
I can’t write anymore today. A buffoon is fucking up or determined to fuck up so many things at once–relations with Canada and Mexico, military policy, health care, foreign trade– that it’s overwhelming. As I’ve written before, there’s a good chance that the American Experiment has failed, and the wise will at least be keeping an eye open on an exit strategy. While I’m here, I will work to make this a better and safer place, but I do not believe that this is the best place for my children to plan their future in.
Polaroid of the Day, and The Story of My Writing Career, zikhrono livrakha
How to open a cat’s mouth
This is one from the archives, it never made it into a journal. I’m guessing I took this picture (in truth, someone else must have taken it, because those are my hands–I think) when I was still doing some veterinary journalism, and that it was for an article.
Writing used to be a great gig. I would write a number of articles per year. I’d do research, interviews, and then an editor would go over them with a fine tooth comb. Sources would be checked. Interviews would be transcribed. I would rewrite them to the editors’ specs, and then we’d go over the final product. For all of this work, I’d get paid enough to make it worth my while, and in my best year freelancing made up about a third of my income.
Then came the internet.
Haiti Veterinary Mission
Please go to this site
and give a hand. Or a few bucks.
There are NO veterinary schools in Haiti. The Christian Veterinary Mission is teaching young Haitians to be veterinary agents, helping them take care of the livestock that is so important to their livelihood.
More Life Lessons, In Which The Totally Useless Dog Eats My Son’s Chocolate Birthday Cake, and Lives to Annoy Other Day.
I really didn’t want another dog.
Y’know that old joke, the one where various people are having a discussion about when life begins (conception, etc), and the old couple has the punchline about life beginning when the kids move out and the dog dies. At this point in my life I’m still not looking forward to when the kids move out, nor do I want the current canine to croak, but when my previous dog died, I have to admit that I was in no hurry to get her replaced.
I had had my own dogs since my junior year in college. After around 35 years of owning various hounds, arctic breeds, retriever crosses, herding dogs, my 16 year-old Australian Cattle Dog, Maddie, was euthanized on a 4th of July. This was just slightly less than a month before my best friend died after a bout with a cancer caused by the radiation that had cured his previous cancer around 20 years earlier. When Mike died, we had been friends for nearly 4o years.
It’s not an astounding revelation that you don’t get to go back to sixth grade and make another decades-long best friendship. You’re just stuck with that permanent sense of loss that occurs when you realize nothing can ever be the same again. I will never have a best friend who was around since I was 10. I suppose that this isn’t astounding. We all know it will happen. Everyone gets to this point, some reach it quite early in life.
Mike had just turned 50, and I was just about to do the same. Plain and simple, I didn’t want another dog. As a veterinarian, I had usually counseled clients to get back into the saddle (more often than not a new pet helps ease the pain of the loss of the old one), and although I had always followed that advice myself, when my best friend died I decided that I was done. I wasn’t in the mood for any more loss. Life brings enough loss without going out and purposely adding to it.
But Jolee bugged me. And bugged me. And then bugged me some more. And went after this the way that only a child who wants a dog can. Then she started finding dogs on PetFinder.com. She worked on my guilt about the divorce. And then I broke. I should’ve known better. I’m a veterinarian, the guy who is on the other side of the exam table when the exasperated parent–usually a mother–comes in and says, “I told them they could have a dog if they would help take care of him!” To which I usually answer, “And you had what evidence to actually believe this claim?”
The truth is that no matter how much kids promise, they are going to fall short. Usually they are going to fall way short. And then they will probably leave for college before the dog dies, which means you’re stuck with the difficulties of caring for the old dog, with his arthritic joints, incontinent bladder, bad eyesight, and failing cognitive abilities. The kids are alright: they do have good intentions. They just have really poor followthrough combined with an inability to accurately assess their desires and capacities. There are a lot of stories about the strong bond between a child and a dog. But no one writes stories about when a child’s interest in the dog gets hijacked for interest in something else (sports, hormone-induced wackiness, cars, music, delinquent behavior. . .) The problem is that it takes forever to say no, but just a few moments of delusion or weakness to say yes. And in general, parents love to say yes.
But I’m digressing. This is about my son’s birthday, my dog Kaleb, who is a total maroon, and the chocolate cake. Every 16 year-old should have a chocolate cake for breakfast on this momentous occasion. Took it out of the refrigerator, put it on the counter, put the 17 candles on (one for good luck), and went upstairs to brush my teeth. Return downstairs, and Genius Mutt is licking the last bits of crumbs off of the floor.
To be continued. . .
Back From Haiti
Was I safe?
The week before I arrived, Guy Philippe, a leader in the 2004 coup to overthrow the government of Jean-Bertrand Aristide, was arrested on drug trafficking charges and extradited to the United States. Seen by some as an affront to the nation’s sovereignty, there were protests in Haiti, and several groups felt it necessary to evacuate their missionaries or aid workers, or else had them seek shelter among United Nations forces. The arrest was also seen as a last-chance effort to apprehend Philippe, as he was days away from being sworn in as a Senator, which would have rendered him immune to prosecution (senators in Haiti have passed a law which places them above the law.)
I was blissfully unaware of all of this before I left. My family was even more unaware. If they had read this account from the NY Times they would have been driving me crazy with phone calls and warning me not to go. My cousin Nettie would have said, “Are you CRAZY?” and my older sister would have been yelling at me on the phone. The article wasn’t published until the day after I left ( a week after the event), highlighting its relative lack of importance in the American mind, especially in the run-up to the Disastrous Inauguration. The arrest was reported a week earlier by the BBC and the Miami Herald.
Haiti is a small country, only slightly larger than Vermont. However, distances are much greater than they would be in the US due to the conditions of the roads. The problems that occurred were far from where I spent my time. My presence in Haiti was relatively cloistered, and if I hadn’t been told about these events I would not have learned of them otherwise in the course of my visit.
Haiti disbanded its military in 1995, partially in response to military coups, partially out of financial necessity. There is a national police force, and the United Nations peacekeeping forces have been in the country for over a decade for police and stability operations. The UN forces are viewed by some as occupiers, and they are responsible as well for the current cholera epidemic. UN soldiers reintroduced cholera to Haiti following the 2010 earthquake, and though on the decline, the disease continues to cause morbidity and mortality.
The term “basket case” arose during WWI as a rather cruel way to refer to a quadruple amputee. It now refers to something or someone that is such a mess that it is unable to help itself, most often a person who is suffering from a mental or emotional problem that renders him or her less than functional.
The Meta-Bug 