!H for health
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agk's diary
17 January 2022 @ 0650
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written on x61 while the baby breastfeeds
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This diary entry's about three things: health, how
learning and assessment help produce it, and how
current events shape knowledge about it.
* * *
Heath, World Health Org opines, is a complete state
of well-being, not just absence of disease. Contrast
David Werner's take on health. Werner and Sanders
wrote in *Helping Health Workers Learn* (1982):
> Health is self-reliance for the person, family,
> village, and country. Do you think this is true?
I think health's sort of self-reliance. Self-reliance
was poisoned in my country by politics promoting
selfishness. People are rational, dependent animals,
according to Alasdair MacIntyre's Aristotlelian
virtue ethics. If I don't have to reject interdep-
endence, I agree with Warner.
Phyllis Light, a fifth-generation herbalist in Ala-
bama I studied under in the mid-2000s, critiques the
industry of health, from "natural" to hospital. They
sell a false, selfish ideal, she says. Their bread and
butter depends on the desire they produce for unachiev-
ably perfect fitness, free from lesions and aches,
untroubled by life and behaviorally self-disciplined.
In the south of our country, she holds, disease is
social, not individual. The body that matters is the
social body. Everyone has pains, injuries, and affl-
iction. People become sick when they fail to meet
responsibilities. Stop taking care of children or
mother, get mean with neighbors, haven't been to
church three weeks now.
That's disease: bitter blood, mean spirits, low
spirits, gall, bile, hot temper, heart so cold it
hurts other people in the community.
* * *
Promoting health starts with learning---taking stock
of the situation: person, family, village, and
country. There's stuff everybody knows and secrets.
Don't act without an idea of what's going on.
Taking stock doesn't stop when interventions start.
BaKongo village health worker Nzoamambu explained
this to medical anthropologist Janzen in the 1960s
with a case study:
A man with fear in his heart was brought to Nzoamam-
bu. Nzoamambu heard the man's heart go ko! ko! ko!,
saw his agitation, and gave him a blend of tranquil-
izing herbs without effect. The man's fear drove him
nearly insane when he regarded the bush in a partic-
ular direction. Nzoamambu sent a search party. They
found the body of a man the patient, a hunter, acci-
dentally killed. Now the man's recovery could begin.
* * *
For almost two years I've reviewed covid case and
death count histograms biweekly. The disease arrived
like goddess Sakpata (smallpox) destroyed 18th-cen-
tury Abomey. Its soldiers sacked Hrounjroto, then
returned with Mahi captives to sell to French slav-
ers. Sakpata followed. Like them, we didn't under-
stand and needed someone to blame.
Clinical medicine learned a lot. We used steroids
and ventilators too early (during the period of
detectable viral replication), when we now (hope-
fully!) use appropriate antivirals and monoclonal
antibodies.
Proning saves lives. We still underuse ECMO in my
country; we expect too much too long from lungs.
The healthcare industry here mines illness for
profit.
Concurrently, public health learned stuff. Covid
lingers in dry air. N95/KN95 masks limit exhaled and
inhaled virion counts. Suspended viral particles
travel via HVAC and plumbing. Ventilation, humidif-
ication, and high-quality filtration drop airborne
concentration. To proxy for covid concentration,
measure carbon dioxide.
After the first case peak in New York City, deaths
peaked 20 days later. Wastewater counts peak 5 days
before cases, 25 before deaths. Cases enter my coun-
try with business travel and initially spread via
ostentatious weddings and parties. Port cities and
wealthy peoples' redoubts peak weeks before inland
cities. Rural crises begin once port cities are
"done with it."
Friday in my country 860,000 people tested positive.
3,000 died. Today's deaths belong to case counts
from 20 days ago (200,000). Holding mortality equal,
expect death counts 3x our previous high the Friday
national death data goes away.
We get 20 more days of national death data---just
enough to judge Omicron's lethality. On 4 Feb, as
rural cases continue to rise, my country's Federal
government will stop collecting nine daily counts
from hospitals:
> 2a: All Hospital Beds
> 2b: All Adult Hospital Beds
> 7: Total Mechanical Ventilators
> 8: Ventilators in Use
> 14: ED Overflow
> 15: ED Overflow and Ventilated
> 16: Previous Day's COVID-19 Deaths
> 21: Previous Day's Remdesivir Used
> 22: Current Inventory Remdesivir
COVID is currently the leading cause of death in my
country. Our Federal administration has decided
we'll fly, self-blinded, into our biggest pandemic
wave in 104 years. A patchwork of county and state-
mandated reporting remains, but those data are hard
to access and reconcile. We'll learn what happened
this year in a MMWR article after the fact, after
midterm elections and more variants.
This isn't the administration's first self-blinding.
It stopped collecting data on breakthrough infections
in vaccinated people before enacting a disastrous
vaccine-only policy last summer. Too late, we learned
mRNA vaccines decrease case severity but don't halt
transmission. Nzoamambu led with meds too. Unlike my
country, he didn't stop assessing a still-sick man.
* * *
My baby's healthy. She learned to crawl this week. I
ache from the booster but turned in my schoolwork on
time. Roommate uses vacation days while Walmart re-
models the bakery. I look to the bush, heart beating
ko! ko! ko! Maybe nothing's there.
Health is a complete state of something, not just
absence of disease. Disease'll always be with us. We
can be decent and care when someone's ability to be
decent fails. We need each other. Striving for health
is striving to be able to rely on each other---creat-
ing supports to make that possible.
Beautiful snow fell last night, thickly blanketed
everything. Linemen repair damage. EMTs collect my
neighbors who need oxygen. I sit here warm and well,
sipping rooibus and makoni tea in china from Cassie,
learning.
* * *
UPDATE (7 Feb): My model was wrong. This wave's daily
death toll has matched--not beat--last winter's in my
country. As cessation of data-reporting arrived we
recorded our fourth-highest daily death toll (4,154),
and an upward trend.
