Sharon July 28th, 2009
A couple of months ago, I got a urinary tract infection. I was visiting family and had been feeling vaguely off all day, when all of a sudden I was hit with a good deal of discomfort in a spot one doesn’t really like to spend that much time attending to, while, say, out to dinner with friends. I was pretty miserable, actually.
I was also nearly certain of what it was – I’d had them before, and the symptoms are pretty hard to mistake. I actually knew that something I’d done recently might actually cause one, but decided to risk it, foolishly, since it was easier. I’d also treated/had treated my UTIs with both allopathic and herbal medicines in the past, and both had worked for me. It was Saturday evening, and conventional medicine would require an extended visit to an emergency room, or waiting miserably until Monday morning when the local urgent care center was open. Neither of these particularly appealed to me – I didn’t want to waste a rare visit to family and friends.
So I took a combination of herbal preparations – cranberry and garlic of course, to fight infection, marshmallow to sooth tissues, nettle and uva ursi… etc… etc… I mostly knew what to use, and I used it.
Now if this were a perfect story about the merits of herbal medicines, I’d be able to say that I cured my UTI, and went home happy. If it were a perfect story about conventional medicine, I’d be able to say that the herbs failed miserably, and then I went to get an antibiotic, and the problem was solved. Either way, in a good story I’d have learned some useful moral, presumably.
But it wasn’t quite like that. What happened was this – I took allopathic ibuprofen for the fever and pain, along with the herbal treatments. And the herbal treatments definitely worked – at least part of the way. By morning, after a lot of cranberry juice and garlic, along with the rest, I felt a lot better – the painkillers and the marshmallow had allowed me to sleep, the infection was no longer acute, my fever was gone, I could mostly pee and I had high hopes that I’d be completely better soon.
Unfortunately, this turned out to be an extremely strong infection, and while it mostly subsided, it never entirely went away, even after several additional treatments. I was able to function perfectly well, with very minimal discomfort, due to the treatments, but I wasn’t entirely healthy, and after four or five days of trying herbal preparations, after returning home from my trip, I broke down and went to the doctor, got an antibiotic and was healed, leaving me with a story that’s hard to derive a useful moral from 
.
Or maybe there’s a better moral than I think. Because I think in many ways, this illustrates a potential normal model for dealing with the medical system. If we are to relocalize our economies, our food systems, our ecologies – we are also going to have to relocalize our medical system – and a relocalized model for medicine may be what we need – not one that excludes either “alternative” or “conventional” medicine, but one that recognizes, just as the bulls-eye diet food system does, that one starts locally, and moves outwards only when necessary.
Right now congress is recognizing what we all know – that energy intensive, expensive industrial medicine probably can’t be made available to every person every time they want it. So what’s needed is a way of thinking about how to ration that kind of medicine – and also how to change our relationship to it, so we don’t feel deprived. Because less industrial medicine is not a deprivation.
I could have written this story precisely the other way around. Last year, my children gave me strep (thanks, kids ), and it was a particularly intractable version of the disease. In many ways the circumstances were the same – I was away from home, reluctant to stop and be sick, too busy for it. The difference was that I went straight to allopathic responses – that is, I got a script for an antibiotic. Unfortunately, this rather nasty infection was resistant, and after two failed treatments with antibiotics which threw my body out of whack so badly that I had a three week menstrual period, was sick for a month and had chronic nausea, I finally used what I knew about herbs, and managed to deal with the problem that way. My intractable strep infection (and the next allopathic step was IV antibiotics in a hospital setting) was finally kicked back with yarrow, oil of oregano and lots of garlic.
The difference between my two strategies was manifest – the herbs may not have “worked” in the sense of fully killing off my infection, but they enabled me to function well, when combined with over the counter allopathic pain killers. The antibiotics didn’t work in any sense – they didn’t affect my infection, and they made me sicker because of their harsh action. Now had they been worth the price, perhaps I wouldn’t have complained – but I think that in many (not all) cases, the reality is that the gentler strategy was a better way to start.
In both cases, it would be possible to say that this is only anecdotal evidence. In both cases it would be possible to observe that I might have done things better initially – that I should have asked my doctor for a different antibiotic up front, or that I should have used different herbs, that I really only should have needed one kind of medicine. To this I would argue that I really only did use one kind of medicine – I was sick, I used medicine. I realize that many h erbs act very differently on the body than some drugs, and that some act similarly. I realize that this is not a perfect parallel – but the truth is that it was all medicine. What mattered, was the order of application.
Now I am the first to admit that this will have to be used with common sense and care – that is, there are plenty of people with medical conditions who already know they respond best to a particular conventional or alternative treatment, who shouldn’t change, since their bodies are stable in that way. There will be acute situations only addressable with one strategy or range of strategies, and times when you shouldn’t mess around with it. These are general rules of thumb with many exceptions, and like all things, they are made for people who are willing to take full advantage of their large cranial capacity . For those who do not want to be responsible for themselves, who do not feel competent or wish to learn more about their bodies, this is probably bad advice. It is both important to learn the basics of self-diagnosis and treatment, and when to admit you don’t know, and to find someone who will to check that lump or the strain. Folks who don’t want to take that level of responsibility won’t like the bullseye diet either .
Let’s think about what I did back in May, when I developed the Urinary Tract Infection. The first thing I did was go local for my basic treatment – to precisely the extent I was able to do so. That is, I used my own knowledge to diagnose myself, something I was totally competent to do in this case – in plenty of other cases I wouldn’t have been, but just as you recognize your allergies or your carpal tunnel acting up, one comes to know one’s body when it is not behaving itself. That knowledge isn’t something one should diminish – indeed, all of us who are parents use that knowledge on bodies that are not our own. We are the ones who decide if childish fevers rate treatment or can be left alone. Often spouses are also subject to our ministry – you are the one who says “you should get that looked at” or “no, honey, I think it is a wart, not a tumor that will kill you next week, so relax.”
The tendency is to devalue this judgement, and certainly, there are reasons for saying that we might want to be careful with it. Like all judgement – certainly like professional medical judgement of all kinds – it is not perfect. But that does not mean we shouldn’t trust it. Sometimes you need a doctor or a naturopath or someone to tell you what you already know, just to be sure. Sometimes all you need is your knowledge, or perhaps an intimate loved one’s knowledge to confirm that nothing serious really is wrong. Sometimes you can learn what you need to know yourself, and sometimes you need help.
The neighborhood practitioner might be the next ring. Sometimes that would be a doctor, other times a nurse or an herbalist, or even an EMT or other practitioner – someone who knows enough to say “this cannot wait” and “this you can take care of at home” or “this we should watch and see.” If we are fortunate in a lower energy world, this person will also know how to do the things that are so often needed – how to deliver a baby when there isn’t time or resources to go elsewhere, how to splint a limb or sew up a small wound, how to tell when the end is near. Manifestly, they must also know their limits – but the neighborhood practitioner – the person willing to trade a little of their time and knowledge to their neighbors will be the first level of response, particularly for those with no access to conventional medicine, who can’t know if they should risk a thousand dollar bill or simply treat things at home.
Had this been the first time I experienced unfamiliar symptoms, I would have gone to a practitioner in the city I was staying in or otherwise local to where I was. Professional medicine has to some degree disdained localism – general practice pays badly and is difficult, so many of us have to go far afield to find a “local” doctor. Hopefully, nurse practitioners, physician’s assistants and well trained naturopaths and other professionals can provide backup – but bringing home local medical care is part and parce of our collective project. How are we to find people who can help us with the process of diagnosis and treatment? We will need those well versed in both natural and conventional medicine to bring their respective knowledge – and perhaps best of all, those who understand both perspectives.
Only if our needs cannot be met by a local practitioner do we go out – this is not how things work now in the medical system. Now, often we are seen by distant specialists we do not really need if we are wealthy or well insured, just to be “safe” and we are not sent outwards, to those who can help us, if we are poor or lack insurance. Finding ways to access the practitioner outer rings will be a central project, if we are not to see lifespans decline and unnecessary harm be done to millions of people for whom we could do better.
But the bullseyes aren’t just about where you find your experts, at home or in town, or at a city hospital far away. They are also about how you treat your situation – from before you contract it until late in the game. And the presumption, with a few exceptions, should be local first.
Medicine of course does not begin with the disease – my urinary tract infection had a back history. Its history was of my own practices, the one that led to contracting it. I actually knew better – I’d noticed that I tended to get UTIs when using store tampons or pads for my period, but I was caught away from home without my reusable models, and was in a hurry, without energy to seek out unbleached options. So the history of my illness, like almost all illnesses, is a history of my lifestyle. My strep was also a history of lifestyle – a frantic push to finish my book, too many speaking engagements, exhaustion – all these meant that my children barely noticed their own infections, while I was laid low for weeks.
It probably would have been possible to prevent both of these illnesses, and attention to issues of prevention, of hygeine and safety, are the beginning of medicine. The most local steps then are these ordinary ones – eating well, getting rest, washing hands, all that boring stuff that everyone talks. It also could have included my taking cranberry as a preventative to my UTI – I know it works, I simply was in a hurry and forgot. Slowing myself down is the first ring of medicine.
Now there are times when one does not want to respond to an illness with self-treatment – no one wants to see someone in a life-or-death situation die because of mistreatment. And yet the vast majority of illnesses and injuries will self-resolve on their own. More than half of all doctor’s appointments are for the treatment of conditions that probably need no or minimal treatment. It is important to be able to recognize those times when you should not respond with self or community level treatment – and to be able to consult resources – a neighborhood practitioner, a good book, the internet to identify these. But most of the time, we are dealing with very ordinary things - but things that cost us something in money, time and energy. Knowing when to act and when not to act is another part of the first ring – all of us at some point must self-diagnose, if only to the point of saying ”ok, I think I need to go to the hospital” or “I think I’m going to be ok.”
We also can respond by thinking in terms of our local conditions – how can we stop ourselves from becoming ill, how can we make ourselves less vulnerable, or more able to bear the stresses we face. For example, perhaps we can begin to eat better, or help others do so. Perhaps we can reduce the use of lawn chemicals or other pollutants in our community. Perhaps we can ask ourselves what we need to be healthier and more secure.
When treatment is called for, for most illnesses, I think the first step is natural medicine from things that are locally available, and ideally, directly available. That is, bullseye medicine would say “look, I have a urinary tract infection – what do I have here that can help me with that.” Instead of rushing to the store to buy “bladder health formula” or whatever, I can look in my garden and on my shelves and ask what I have that might meet my needs. The elder and garlic on my shelves, the nettle and dandelion in my yard – perhaps these are tools that can help me.
Now just as some of us eating from the bullseye diet will have little space, and have to go afield for their food, so too will that be in medicine – some of us will have land and woods full of medicinal herbs and the knowledge to use them, others will need to go out, to speak to someone who knows, the local herbalist, the person who has a little knowledge they can pass on. Perhaps too they will have herbs to offer and share. Again, the first place to look is locally - because only when we treat locally do we know if we are using populations of plants wisely, or growing what our community needs.
But what if nothing local serves? What if we need more? Well, that’s when the distant things and perhaps conventional medicine begin to step in – we can say “this is not enough, or this is not the right path” and move on from there. In a few cases, we won’t have time – we’ll have to rush right to one solution or another, but most of the time we do – we know this because even in quite urgent medical situations, often people spend a lot of time hurrying up and waiting. We may think there’s no time to see if the herbs can do something, but the reality is that antibiotics take 48 hours too, that seeing the specialist can take a month. Perhaps we can get over our fear that we must hurry if we accept that all medicine takes time, and while there are acute situations in which there is no time, the vast majority of situations don’t fall in that category. Often our sense of lack of time to allow treatments to work is the fact that we are under so much time pressure – but the truth is that we can’t make ourselves heal any faster than our bodies can heal.
So the next step might be different herbs, used from different places. Many medicinal plants are threatened, and if we were to give primacy to the local and prolific, to turn only to the rare and distant when we need it, we’d have enough. There are things I cannot grow, there are things from far away that can provide good treatment. Or perhaps the next step is to talk to someone else, from another community, or to seek another kind of treatment.
Perhaps now would be the time to consider allopathic drugs. It is awfully hard to go local for pharmaceuticals – even if you live near the local Pfizer research lab, there’s nothing really local about a petroleum synthesized drug to help you maintain an erection or good blood pressure. On the other hand, one can in some cases look to “open source” drugs, those that are no longer under patent, and can be produced by many companies. These are often cheaper, and in some cases, if an extreme disruption of society were to occur, it is possible that local chemists might collaborate with people who are sick to produce these drugs – some drugs have very simple chemical components, others, not so much. Only you and your doctor(s) know if this is a good choice for you, but it is perhaps a useful rule of thumb to at least consider this option, however briefly.
When we need it, we would hope that the full range of medicine would be there for us – even though it is not for many billions of people. But the more of it we can keep available for emergencies, the better off we will be. But keeping the infrastructure of conventional medicine available to us depends in large part on not overusing it – we are already having to admit we can’t afford a universal health care that treats conventional medicine as a given, and gives it out without limit. It should only be sought when we need it – which means it will be a first step for type 1 diabetics and people with multiple life threatening physical traumas, and a last step for kids with ear infections and adults with obesity related hypertension.
Besides practitioners and treatments, there’s another portion of medicine that can be localized – where we are cared for, and how. You need a nurse to give medications to 76 elderly people strapped to their beds in nursing homes, because it would be easy to make a mistake. You only need an ordinary person willing to learn to give their mother her medication at home, in her room in your house.
You need nurses and doctors to provide care for the dying in a high tech hospital where they are strapped to breathing machines and blood pressure monitors and heart monitors. You only need loved ones, community support and perhaps a kind hospice worker a few times a week to care for a dying person in their own bed.
You need a doctor and a labor nurse and a neonatologist to deliver a baby in a hospital for reasons of liability – but you only need a trained midwife and a loving helper to deliver a baby at home most of the time. You need a professional consultant to help a new mother navigate her nursing difficulties if there are no other women who have nursed around her – if there are, you often need only them.
There are a whole host of situations in which the roles played by the medical system can be met by family, by friends, by community – those who are willing to do the work of nursing the sick, caring for the dying and tending new lives. Again, it is possible to begin from the local. There will still be times for the C-section, for the nursing home – but they are not most of the time.
It would be a tragedy if, in the times we need them, the obstetrician, the surgeon, the herbalist, the gerontogist weren’t there – or were there, and out of our reach as we suffer and die. There are times when we have to go all the way out to the outer circles of our bullseye medical system, and those are real needs. We know, however, we cannot afford to use those constantly, and we cannot afford ethically to use the current model, in which those who are affluent or lucky enough to have insurance get more care than they often need, and those who are poor or unlucky cannot access the outer rings.
Instead, we need to start at the local in the 90% of cases when we can do so safely. We need to rely on one another, recognizing the limits of our knowledge, and recognizing what responses are appropriate and what are not, but presuming – beginning from the idea that we can start at the center and go outwards, rather than responding to every crisis by going further and further away.
Shalom,
Sharon