STILL OUT THERE…WAITING


 It’s a bone chilling March morning in Korea, and the USS ST. LOUIS is off the southeastern coast, anchored at Pohang.  I’m finishing up in sick bay, having just seen my tenth case of gastroenteritis.  The last sailor told me word is spreading on board to stock up on absorbent paper products. 

Damn.  My goal was to get through the 8-month deployment without an epidemic.

I eventually learned we had distilled water from the harbor, violating Navy Regs, so we wouldn’t have to restrict water use or get underway to distill at sea.  I had questioned the Chief Engineer about our water supply and was assured we had plenty for the boilers and personal use.  I should have known better than to believe a snipe.

Several days and 300 cases later, an 80% attack rate, I was 10 pounds lighter, but the epidemic had finally “run” its course.  We were not fully mission prepared during that time.  To those who feel that funding military strength is more important than public health, I remind them that throughout history, disease has decimated military units and affected more troops than battle.

Many forget that Americans used to die from measles, cholera, typhus, rabies and tuberculosis.  Yellow fever devastated Memphis.  Malaria was as bad an enemy as the Japanese for the First Marine Division on Guadalcanal in 1942-43.  These diseases have not disappeared.  They are still out there, waiting,    waiting for us to let our guard down, to ignore the fact that the single biggest factor increasing our longevity has been improved public health.  We fortunately live in a society where many scourges are controlled – for now.

I remember how sick and photophobic I was with measles, which can kill one in a thousand.  A brother had polio; another mumps meningitis.  My father had tuberculosis; my mother scarlet fever and pertussis.  Americans used to fear crowds in summertime because of the risk of catching polio.  Today, these conditions make headlines; back then, they were “usual childhood diseases.”

Adjusted for inflation, Pima County has not increased public health funding in 15 years, despite a near doubling of population.  They are several employees under full staffing.  A bad economy not only decreases funding but increases demand, as un- and under employment increase.  Fees for immunizations, restaurant inspections, animal licensure, family planning, STD services and TB treatment will increase, because while such tests save money and misery, people now have short term,  more important concerns, like eating.  I predict more unwanted children, a food borne illness outbreak, increase in STDs, more unlicensed dogs and Arizona keeping its top ranking among the states for congenital syphilis.  I thought we were finished with that one. 

Immunization preventable diseases, HIV, MRSA, rabies and pandemic flu have no economic boundaries.  We take for granted no disease in the food we buy or in the restaurants we visit.  This is not a coincidence or the Eleventh Bill of Rights.  But we face a cut of $1.4 million from the local public health budget.  Cryptosporidium infected 400,000 in Milwaukee in 1993 and killed 100.  That bug is not restricted to Wisconsin; cholera is not restricted to Zimbabwe; bad lettuce not restricted to California; or bad peanuts to Georgia.  Lack of regulation kills people as well as making them unemployed and broke. 

Ten per cent of Pima County’s active TB cases are homeless, and we cannot afford to house them until they are non-infectious.  Nor can we afford to pay a radiologist to read their X-Rays.  Therefore, the number who complete therapy will decrease, fostering drug resistance and setting the stage for an outbreak, first in the homeless shelters, and from there, to the community — you and me.  Maybe people shouldn’t be homeless, but they are.  That’s reality.  Financial robber barons get bonuses for ruining the economy, TB and syphilis are making a comeback, and I feel I’m back in the 19th century. 

We must make public health a priority.  There’s a lot of bad stuff outside the walls of our civilization, waiting for us to open the gates.  And that’s exactly what will happen if we inadequately fund public health.  Sure, I believe in the value of arts and sports.  But adequate public health allows people to live long enough to become artists or play sports.  It’s time that the public learns that vaccines save many orders of magnitude (10n, where n is order) more lives than they possibly hurt.  And it is time that the public learns that many diseases aren’t prevalent today because of scientific advances in general and public health in particular, not good fortune, vibrations, touch therapy or magical thinking.

A strong public health commitment here in Arizona and across America is an important part of national security.  Tell the Supervisors public health funding saves money and lives.  The department is already severely stretched to where further cuts will impact our safety.  Tell them if we ignore the benefits that come from good public health, we will reap the consequences that will surely develop.  Count on it.  Tell them the human and dollar cost of those problems will be incomprehensible and not amenable to sending good vibes or touching each other. 

Count on that, too.

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