Cholera and a sort of book review

Cover of

Cover of The Ghost Map

One of my favorite books is “The Ghost Map” , written by Steven Johnson. It chronicles the beginning of modern epidemiology (science that studies the spread of disease in humans) by following two different men of a learning- a scientist named John Snow and Reverend Henry Whitehead- during the London cholera epidemic of 1854. By investigating the cases of cholera in the neighborhood they served, they discovered its transmission via water and Dr. Snow created epidemiological mapping that is still used (albeit on computer) to this day. The book is extremely well written and engaging, so definitely check it out. (This post is just an attempt to give a crash course on the topic cause IT’S SUPER COOL GUYS)

19th Century science and medicine can be a distant concept at best so I will  set the scene.  *a-HEM*

We did not always believe germs caused disease. For over a thousand years doctors and scientists held to Miasma theory. In Western medicine it is attributed to Galen,a hugely influential Greek physician, surgeon, and philosopher born in AD 129 ,and it states that illness comes from “bad air” called “miasmata” or “night air”. The ancient Chinese and Indian societies also had the same concepts even earlier than the Greeks.  All agreed that bad air’s source could be rotting organic matter, water containing waste of any kind, poor hygiene, and air pollution. Miasma made the individuals who inhaled it ill, and that individuals did not pass that illness on to other humans- only individuals who had direct contact with the bad air would fall ill. Western belief also held that bad air could come from the worms in ulcers of plague victims (I wish I were kidding).

270px-Cholera_art

poisonous air transmitting illness by Robert Seymour, 19th Century

[We now know that illness is caused by germs.  Some illnesses are airborne, waterborne or transmitted by plants/animals/insects, and that almost all can be transmitted from person to person by various pathways. We’ve come a long way.]

tl;dr: Scientists and doctors adhered to the logic “If I have a strong negative visceral reaction to this smell, and the smell is near those who are ill, then the smell must be making these individuals ill.” (which, incidentally, I think is an example of Cum Hoc, Ergo Propter Hoc or the false cause fallacy) In the Ghost Map, Johnson hypothesizes that Miasma theory may have stuck around as long as it did because of our physiological and psychological relationship with our sense of smell. I would add that Miasma theory  dovetailed nicely into the social and cultural views (held by many then, and still held by some people now) that those of the lower class would naturally be more ill and dirty as punishment for their moral failings. Luckily for us, Dr. Snow was a Miasma Theory skeptic, and this skepticism was ultimately what allowed him to make his groundbreaking discovery. The other difficulty in connecting germs with illness was that no one knew microbes existed until Anton van Leeuwenhoek and Robert Hooke’s first spotted them under microscopes in the 17th Century.

Re-occurring Cholera pandemics first  began when the illness left the Indian subcontinent in 1817 (where the disease is thought to have originated and existed for thousands of years, the first written description is in Sanskrit from the 5th Century) spreading first to Russia, then Europe and the rest of the world.  The London Cholera Outbreak of 1854 was part of a larger  Cholera pandemic that lasted from 1839-1856. So by the time of Dr. Snow and the Reverend’s work, people were fairly familiar with the signs of Cholera, but no nearer to stopping it than they were in the previous pandemics.

Cholera is caused by a bacteria called Vibrio cholerae that lives in contaminated water (containing animal or human waste). Individuals become infected when they ingest contaminated water or if they ingest items that have come in contact with contaminated water such as shellfish or oysters. The symptoms of cholera are unique and dramatic-  rapid and severe diarrhea and vomiting until the illness has taken its course. Choleric diarrhea is described as “rice water” and individuals may develop blue tinged skin as they lose fluids. The very young and very old have higher susceptibility, and it has a 50% fatality rate if individuals are not kept hydrated. There are vaccines for cholera as well as a cure- antibiotics or constant water and electrolytes- but since citizens of the 1800s had neither the knowledge nor the science, cholera became a devastating plague. (Historians believe cholera killed Tchaikovsky, King Charles X of France, and U.S. President James K. Polk)

The troubling thing is that something as easily treated and nasty as Cholera is still prevalent in the 21st Century. After the earthquake in Haiti in 2010, the government and the U.N. were unable to secure the water supply which led to the death of 8,000 people.  Cholera will continue to kill 1,000 Haitians a year until it is eradicated from the country.  Just yesterday South Sudan declared an outbreak that has infected 171 and killed 81. “Cholera broke out in the capital last year, five months into a civil war that is still ongoing over a year later. That outbreak was devastating infecting more than 6,000 people across 16 counties and resulted in the deaths of 167.” (Al Jazeera English)

As of 2010, it has caused  58,000–130,000 deaths a year(1). The scary and difficult part of this disease is that some strains can cause death in 2 hours and it infects individuals that are already in sometimes war-torn,devastated, under-served and impoverished communities. 

What can be done? The consensus among the public health community is that prevention and preparedness on the part of governments is critical. Complete and thorough sanitation of drinking water that that is available to the entire population is essential. When or if there is a cholera outbreak, notifying the public, vaccinating and locating the source of the contamination is critical to slowing the spread. Continuing to aid countries in their improvement of  infrastructure and communication of public health departments and health care communities in the developing world will be crucial to wiping out Cholera for good.

Want to know more about cholera? Check out the links below

Report on Cholera in India from World Health Organization

Harvard- Contagion: Historical Views of Diseases and Epidemics

Cholera Fact Sheet World Health Organization

Former U.S. President Bill Clinton and the Haiti Cholera Outbreak

Basic Principles of Epidemiology

Sources

1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY et al. (December 15, 2012). “Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.

writers write- a personal and professional- perfesional? update

Yesterday I had the opportunity to meet Professor Howard Markel, who is the head of the History of Medicine department here at the University of Michigan and a somewhat high profile author. Needless to say I was mildly starstruck and probably talked too much. I had contacted him because all of his work is something I aspire to do someday, I want to do some sort of independent study or work with one of his projects, and also to get his advice about starting the school of public health blog/student organization in the fall.

In response to my requests, he’s going to try and see if I can help with the web encyclopedia  about the American Flu Epidemic of 1918 that he started. He gave me sound advice about starting the blog/club (don’t publish everything, obviously, and get some money), sound advice about writing and a copy of one of his books.

His advice about writing was “I hate saying this, because I know I hated hearing it when I was younger, but read and write a lot. Writers write. Read other authors, see what works what doesn’t. Find your voice and write for an audience. It’s fun writing for yourself, but writers write for other people. I’ve written for an audience of 3, and I’ve written for an audience of 3 million- and writing for 3 million is a lot more fun”

I have to agree that writing for an audience is more fun. Will I ever write for 3 million people? Who knows. I mean I write for (technically) 930 or so of you (if any of you actually read my original posts, thank you hello, you’re beautiful) and I enjoy it thoroughly.

But he’s right. Writers write. And I have put off a lot of my personal writing because A. I’ve been busy but also B. because I have worried too much about the exactly right timing and perfection so much that I haven’t been getting any of my thoughts down when they occur to me or finished projects and gotten them out there despite them not being “just right”

If I’m going to be a writer I gotta just kick things out that are as good as I can make them. I can only get better through practice.

opinion: public health needs an image change and more political oomph

I am not yet a full fledged Public Health Professional, but I am a third of the way through becoming one, so I can share the impression I have gotten about our field’s image so far- we’re a little bit confused. There’s nothing wrong with that at all, because we still do amazing work and will continue to be a groundbreaking and essential field. No the confusion comes from our, for lack of a better term, “brand name”- what does Public Health mean now, here in the 21st Century? I think most all of the faculty and students here at SPH could give you our thoughts on this question, but the answers would not all be the same. That is also perfectly ok- public health means different things to us, it means different things based on the work we currently do and  what brought us to SPH in the first place. The problem is that when we try to talk about public health to the outside world, different definitions and  goals can lead to dysfunction.

Most of the time when I describe public health to individuals outside of the community, I give  a simplified description of  epidemiology, even though that’s not even my program, because that definition is easiest for laypeople  to understand and the area of public health that has been most visible to America for the past 50-100 years. And I usually feel bad about it, because it does a disservice to Epidemiology, a complex and fascinating field,  and my wonderful program Health Behavior and Health Education,and it does a disservice to everyone else in Public Health.

Public health is much broader than the spread of disease only, and quite honestly, epidemiology as everyone has known it is becoming less of a pressing focus in the United States. Sure we still have whooping cough, measles and other contagious illness that are essential to focus on, but more than anything, Americans today suffer from chronic conditions that are not contagious. So other facets of the Public Health field have to step up. We have to show everyone its importance and redefine public health in America in the process. A tall order.

On the one hand, we need the recognition, understanding and respect of our new image by of the wider community, but more crucially, we need funding. It seems callous to point out money in the face of the good and worthy work that we do, but if we don’t get funding we don’t get things done. End of story.

From what I gather, the solution to these problems is to A. have an agreed upon definition of public health that represents our goals and our multifaceted discipline B. evaluate evaluate evaluate our programs and practices to see if they really are worth the money being spent on them and C. try to get more political. I know that there are plenty of great people working in the nation’s capital and elsewhere to get public health the recognition it needs, but it’s not making as much of a splash as it could be, and we certainly don’t have name recognition of any champions of public health. As far as I can see the best name recognition we currently have is the CDC, and even they don’t have the same amount of clout as say, the Pentagon or the FTC. (digressing into my political views, it’s unsurprising to me that Americans pay more attention to war and money than health)

I plan on using at least a small portion of my career and energies into talking the ears off of anyone who expresses interest in public health and its potential image change and its need for a greater spotlight and influence. We have a lot to give, we just need the push to get us there.

internship season

Student Life

In the crazy wrap up of the semester, it’s been difficult to work on all of my online writing projects, but now that it’s summer I will have more time- in theory. Because  summer and for SPH students transitioning into second year, that means it’s internship season. We are all dispersed to new locations across Michigan, the United States and across the globe to see what public health looks like in action. It’s incredibly exciting and I cannot wait to see the wonderful work my classmates and colleagues will accomplish and learn this summer. It will be a summer of growth and challenge, that’s for certain.

My internship is with the University of Michigan’s MHealthy- a branch of their human resources department devoted to Health and Wellness of employees of the university. I am very excited to begin my work on projects and interventions, specifically in the Stress Management and…

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My Spell Check doesn’t recognize “Health Informatics”

Student Life

My post title reflects microsoft word’s ignorance and also my own ignorance before I came to U of M.  At its most basic, health informatics studies, creates and utilizes technology to monitor, improve and communicate health information. This is a big undertaking and because of that, this field is rapidly expanding in knowledge and opportunities for individuals from a wide array of disciplines to contribute- Epidemiologists, Public Administrators,Information Technologists, Health Behavior specialists and many more.
In my introductory class for Health Informatics our study was as far ranging as the field itself. We studied the use of computers, programs, apps and tools within biomedical research, public health work, medical care, consumer healthcare and the work being done to improve health information infrastructure.

Health informatics in the United States is  rapidly growing partially because of the HITECH act passed by President Obama in 2009. This act provided money to the Department of Health and Human Services…

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Ebola as an Epidemiology Student

Student Life

aparna

That squiggly blue line in a sea of red…the little virus that has the world in uproar…you’ve heard about it…the mysterious and deadly Ebola virus!

about-ebola(picture from CDC)

This year’s Ebola epidemic has been one of the deadliest and largest in history, and as a first year Epidemiology student, there is almost nothing else that we talk about with such fervor and intrigue. On the other hand, because I’m in public health, the questions that I have received directly from family and friends, or indirectly from wild, hysterical posts on social media, have made me think seriously about the effect the media has on all of us….

So today I present you with the facts about Ebola. There is absolutely no reason for chaos, panic, fear and/or hostility for people dying of Ebola in America. We have the resources to deal with the virus – it is West Africa…

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Books About Me

Student Life

Hello there! My name is Peggy Korpela. Pleased to meet all of you 🙂 I’m a first year School of Public Health student, and a new SPH student blogger. I’m in the Health Behavior and Health Education program, heading for my Masters in Public Health (M.P.H.) My Bachelors degree is in Human Biology with a minor in Bioethics, Humanities, and Society. I run a blog called thebiobabe that features science, health, medicine, and politics and I’m also a submissions editor for SciNote.org.

So in thinking about writing my first blog post, I decided to  introduce myself by way of my 2  favorite Public Health/Biology books. Without further ado, here they are:

1.Steven Johnson’s “The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How it Changed Science, Cities and the Modern World “

I love The Ghost Map because not only is it extremely well written nonfiction, but it’s about…

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