Both my paternal grandmother and my father’s second wife, my step-mother (not the same person I refer to generally here as my step-mother – that marriage ended years ago) had had polio in their youth, and I saw in both of them the consequences of that disease – the heavy brace on my step-mother’s leg, and the struggle to keep up with her children; the gradual decline in her health as my grandmother moved back, from the cane she’d laboriously achieved over years of rehabilitation, back to the walker, and then the wheelchair, as her last years were rendered miserable by post-polio syndrome.   How could I not see the polio vaccine as a gift?  Or tetanus, that scourge of anyone who works with dirt, that unbelievably painful and fatal illness.  Who isn’t glad that there’s a rabies vaccine for our pets so that summers don’t end like a Harper Lee novel?

My oldest son, as you all know, is autistic.  It would be easy to blame the mercury content of his vaccines – except that my son was born on the cusp of real awareness of this, so for the most part, he didn’t have mercury laced vaccines.  We declined some vaccines – chicken pox and thankfully, rotavirus.  We accepted others.  But I don’t see an answer to his condition there – like all parents, we made the best choices we could, and if I’m wrong, and there were consequences, well, they were still the best choices we could, though I might wish for better.

I think it behooves us to speak not generally of “vaccines” but of specific vaccines – of the risks and benefits of each one.  They are not all the same – vaccinations have managed to remove the scourge of polio – if you can’t imagine how terrifying it was in the summers when that swept through the cities, try – read a novel in which it happens.  Tetanus is, I personally believe, a wise choice for everyone – the bacteria resides in soil, and what we do to care for our land puts us at greater risk. 

On the other hand, I am somewhat more skeptical of the flu vaccine.  I have received it in the past – when we cared for my husband’s grandparents, it was my profound fear that my children would bring home something that would kill them, and we considered the benefit analysis to be positive – even if the shot wasn’t fully effective in older people, we could perhaps reduce the risk of exposure.

I probably will get an H1N1 vaccine this year – mostly to avoid spreading the flu to extended family members with health issues.  While I think that some of the claims about the effects of the flu vaccine are undersupported by research, I also think my body can handle it, and, frankly, I think it is worth a little shot in the arm to marginally reduce my risk of killing some elderly family member.   But that doesn’t change the fact that it seems reasonably clear that there are more effective ways to address influenza – and that we won’t use the most effective tools we have.

In the current flu outbreak, there does seem to be some evidence that younger people are getting sicker.  I haven’t fully gone back and read the study though, to see what the absolute numbers are.  Nor is it clear to me that all the cases were confirmed as H1N1 – about four years ago, something similar was reported in an early winter flu that seemed to have a high mortality rate among young children – but that flu season turned out not to have a higher overall mortality rate.  There are things we will not know until we know them.

A lot of the anti-vaccination material out there is pretty poorly reasoned – but this article from the Atlantic, I think does a fairly good job of exploring the limits of the flu vaccine.   It doesn’t answer all the questions – that is, looking back at some of the papers, it seems like we may have some evidence that vaccinating school children would reduce overall mortality in the elderly and among those with immune-compromised systems – they are the least likely to get severely ill, of course, but since school kids are among the most likely people to transmit the disease, the overall benefit might be sufficient – but we’re not sure of that.

But what’s really important about the article is the end – which points out that we eschew the methods that we *know* would reduce flu mortality – ie, staying away from one another during an outbreak.  We have tools to keep the elderly and ill safer than they are – but we don’t use them because the industrial economy is so adamant that it cannot afford us time to be sick, or to be safe. 

This, I think is the most important part of all of this – I’ve written before about the ways that the industrial economy tries to subsume us all, and our time.  Women who want to nurse babies can’t be freed – they must work.  Sick people can’t stay home.  Parents can’t care for sick children.  The industrial economy must go on – it does not serve our needs, we only serve its.  And this is the true purpose of the flu vaccine – not to prevent deaths, but to continue on our merry ways *without disrupting the economy.*  And this alone makes me suspicious of the process.

Of course most of us can’t afford to buck the dominant paradigm – if we stay home when flu is running through our office, we’ll be fired.  If we take the kids out of school, someone has to stay home with them.  And who has more than three days of groceries at home anyway?  Of course, our government could help here – but it has chosen a side – the economy uber alles.

Sharon

What I found is troubling, but perhaps not quite what some of its critics are saying.  What’s most troubling about it is the idea that these policies could be enacted for a low-severity flu virus like the present form of H1N1.  I think that this is extremely disturbing – the level of hype about pandemic influenza is so high that it is extremely worrisome to imagine that the Massachusetts governor could apply these to a low-severity virus.   This bill *absolutely* must include clearer language about when a pandemic emergency can be declared, and about the number of medical agencies that must achieve consensus that there is just cause for such an emergency.  The absence of sufficient language in that regard should be enough to kill the bill.

That said, however, most of the most controversial requirements are medically appropriate for preventing the spread of disease, assuming that the disease was a high mortality, highly contagious disease such as Ebola, Plague, a very high mortality flu, etc….  It should not be applied to any medical emergency that doesn’t meet both the criteria of high mortality (in excess of 5%), and *also* high degrees of transmissability – ie, airborn or easily contact-spread virii only.  What the bill needs is a set of restrictive premises under which it could be enacted, and a lot more appropriate medical language.  There are also some real concerns, particular permission for law enforcement officials to deem appropriate arrest without a warrant, to enter buildings without a warrant, and the lack of parameters about what constitutes “decontamination of persons”.  Again, there’s a lot not to like here, and I think the bill should be killed and sent back for rewriting.

But I’d like for a second to talk about the medical realities of a real, high mortality pandemic – consider, for example, the outbreak of pneumonic plague that occurred in Ziketan in Northwest China over the summer.  Pneumonic plague is airborn, highly contagious, is often fatal as quickly as 24 hours after being contracted and has a mortality rate of nearly 100% without aggressive early treatment within 24 hours of symptoms, and mortality rates above 20% with aggressive antibiotic treatment.  7 days of heavy antibiotic treatment in advance will almost always prevent the spread of the disease.

Now we are all very fortunate that during the last outbreak of pneumonic plague, it occurred in very isolated northern china, and that no one got on a plane that was infected.  The total deaths were limited to three, only 12 people actually contracted the disease.  But this is the case *because* China enacted policies that are pretty much the ones described in the Massachusetts laws – they isolated the entire town, quarantined people in their houses, with strong penalties for leaving them, they treated anyone who might have been exposed with antibiotics, whether they wanted them or not, they commandeered facilities and enacted martial law.

Had they not done so, had a person carrying pneumonic plague, say hopped a flight to London and survived 48 hours touring that city, while his flightmates went on to New York, Paris and Johannesburg, we might have had a world-wide outbreak of pneumonic plague.  In that situation, any rational government would do what China did – quarantine, close the cities, ground the planes, mandate antibiotic treatment or quarantine for everyone exposed – period.  And quite honestly, it would be insane to do otherwise – the rights of other people stop well short of killing thousands of other people.

Everyone raise your hands who would be happy with a purely voluntary treatement and quarantine policy in this case?  Every parent who has ever known any other parent to send a sick kid to school, raise your hands?  Every adult who has ever had a co-worker come sick to work, even when they shouldn’t have, raise your hands.  Everyone who has ever met an illegal immigrant who would be unlikely to come forward to for any program involving “authorities” raise your hand.  Seriously, I think while it is deeply important not to overstate the risks of H1N1 or to allow them to constrain our freedoms, it is also important to recognize that in a world where people travel the globe, it is possible to imagine a situation in which the transmission of a major illness can only be constrained with the restriction of personal freedoms. 

I generally support the right of parents and adults to choose to be vaccinated or not – and much of the controversy focuses on the provision for vaccines - Fox News talks about forcible vaccinations. In fact, the bill provides for forcible vaccinations *or* quarantine – that is, if you are exposed to the disease or living in an area where a pandemic is rampant, if you decline vaccination, you must be quarantined.  I have no ethical problem with this, again, provided that reasonable provisions are made to make sure that pandemic response is enacted only in the case of a high mortality outbreak.  I think that given the limited testing of the H1N1 vaccine, it is perfectly reasonable, in a low mortality outbreak like the present one for everyone to have the right of refusal. 

But that is not the case were the H1N1 documentably to mutate into a high mortality disease – I agree that even in those cases, no one should be forced to take the vaccine.  But if you aren’t going to take it, *in a situation where there is a high mortality virus to which you could expose others*  you do have an obligation not to infect others – ie, to accept quarantine.  This cannot cause undue hardship because the Massachusetts law explicitly provides for unemployment payments for anyone who either is in quarantine themselves or who is required to tend a quarantined child, and prohibits with legal penalties the firing of anyone because they have been put into quarantine.  IMHO, this is about as just an arrangement as can possibly be made – my family might well refuse a vaccine I believed to be dangerous or ineffective, but I don’t believe that the quarantine obligation is then unfairly onerous – again, assuming that the regulations are enacted only in situations of great exigency.

The reality is this – there are occasions in which personal freedoms are subsumed in a crisis.  I understand that all Americans have excellent reason to fear, in the years since 9/11, the use of a crisis as excuse to limit our freedoms – this is legitimate, and it is right. But it is also the case that there are times when all of us using our own personal judgement to make decisions are unacceptable – and we know this.  It is a difficult thing to balance these, but I think it is important for Massachusetts residents to oppose senate bill 2028 *on the correct grounds* – not because the state never has the right to subsume individual rights the rights of the public not to die, but because they only rarely, and in extreme exigency do.

I think that Senate Bill 2028 is a failed bill, that it should not pass the House in Massachusetts and it needs to be rewritten and amended.  That said, however, it is also necessary at times for us to be able to constrain the spread of disease – because the odds are excellent that sooner or later, some of us will need someone to articulate the rights of other people not to be exposed.

Sharon

 “I would like to sell you some hunger insurance. Are you insured against hunger? Perhaps you should be! Without this coverage, you may find it impossible to continue to afford feeding yourself and your family. With this coverage, not only will you be assured of continuing to get at least some food, but so will I. In fact, thanks to this plan, I will get to eat very, very well indeed.

The company is in a position to demand lower prices for food from the food providers, and can even pass some of these savings on to you. (But the fine folks in the hunger insurance company do have to eat too, you know.) Of course, the food providers try to make up the difference by charging those without hunger insurance much higher prices, but how can anyone blame them? That’s just market economics. There may also be some food-related benefits, such as lower rental rates on bowls, spoons, napkins and feeding tubes (check the details of your plan).”

Read the whole thing.  You’ll laugh, but nervously.

 What I was watching was the inanity of the protests against “socialized” medicine and the crazy objections to the idea that poor people shouldn’t die sooner than rich ones.  The emphasis is mostly on a tiny number of examples, many of this false or based on incorrect assumptions, of people who are in some way unhappy with their European or Canadian health care systems.  Now I’m pretty sure if we worked at it, we could find an equal or perhaps even greater (gee, how unlikely is that) number of Americans displeased by their health care system, but you’d never know that.

I was thinking about this as I sat visiting with my aunt, who had recently returned from a summer trip to Ireland, where she had sojurned with her 88 year old mother and 9 year old daughter.  Now her daughter “Lucy” has epilepsy and a number of other disabilities, but hadn’t had a seizure in several years.  While they were travelling in rural Ireland, however, Lucy had a sudden, severe seizure, and my aunt got to experience British medicine first hand.

My aunt’s commentary on this was fairly simple.  She noted that in America, when you enter an emergency room, you are asked three things – your name, the nature of the complaint, and how will you be paying for this.  When she and her daughter arrived by ambulance at the emergency room in Ireland, she was asked, again, three things.  Her name, the nature of the complaint, and would she like a cup of tea?

The experienced with National Health, she observed, was hugely different from that of American hospitals after Lucy’s seizure – instead of doing dozens of tests on Lucy, they did one, the relevant one.  As Lucy was showing signs of recovery that evening, they held her for observation and released her, rather than insisting she remain in hospital for several extra days, just in case, as has happened in the US.  She was seen rapidly, the emergency room was calm and the doctors responsive, and despite the fact that they were not British citizens, there was no charge.  Like everyone I know who has ever experienced any kind of national health system, my aunt’s reaction was that if we did half as well, it would be a huge improvement.  My own observations on that front are similar.

And this, of course, is the clincher – I’ve never, ever, ever heard anyone, from any country with any kind of national health service suggest that they would rather live under the US system.  Not one. 

Contrast Lucy and my aunt’s experience in an emergency room with my last experience in an ER.  My husband’s grandmother, a few months after the death of her husband, took a wrong turn in the dark while visiting her cousin for Passover, and fell down a flight of stairs.  She broke her neck, her leg and her collarbone.  When one says she “broke her neck” it sounds as though she must have died instantly, but that’s not the case.

What happened is this – her elderly cousin, sole caregiver for her husband who had had a stroke, rode to the hospital with her, after calling us to come.  We were visiting my MIL across NY City, and I immediately got up in the night, dressed and took a cab to Queens from Manhattan.  By the time I arrived at the hospital, Inge’s cousin had returned to her husband, because he could not be safely left alone.  When I arrived, she’d been at the hospital for an hour, without a single person examining her. She was still strapped to the stretcher, in an ice cold room without a single blanket (she was wearing only a light nightgown, which was up above her waste, where she was completely exposed), and was weeping with pain and cold.  When I finally managed to orient her, and asked a nurse to attend to the fact that she was in acute pain, the nurse said “Oh, yes, she had a fall, I’m sure she’s just sore.”  This was in reference to an 80 year old woman who had fallen down a long flight of stairs, and who had a visible broken bone, as no one can keep their leg at that angle.

I finally got her warm (she was in shock, very easily recognizable, dangerous and totally ignored) and pain medication, and she became lucid.  A doctor, coming to examine her (three hours after arriving) said that even though the CT scan machine was occupied and even though she was having head and neck pain, he thought she probably didn’t have any serious neck injury, and he sat her upright for her examination, even though that’s just about the first thing anyone learns when they do any medical examination – never jostle a head or neck injury about.   He told her she’d just need light surgery for her broken leg (missed the collarbone entirely, along with the neck injury) and that she could be released to rehab the next day.  I was the one who insisted that she have her neck scanned, and, of course, it turned out that she had a severe break.

We spent 12 hours in the emergency room with beds literally so closely crammed together that there was no room for a chair, and chairs were forbidden.  I was 3 months pregnant with Asher, and I stood on my feet for 11 consecutive hours, until Eric’s father arrived to take over attending her.  She was finally admitted, after the neck injury and collarbone were detected. 

Eric’s grandmother was slightly deaf, and when forced to lie flat on her back, often couldn’t understand what was being said to her.  When she realized her neck was broken and she would require massive surgery to repair it, she was very concerned that her wishes that no heroic measures be taken be respected if it seemed likely she would die.  My husband and I were the bearers of her power of attorney, and asked that it be invoked, and she agreed – we asked the hospital employees to make absolutely sure they were familiar with her documentation (which we had on hand, sent over by her attorney), and that before any major medical procedure occurred, we be consulted.  They agreed.  Then, during the early hours of the morning, while my husband and I were asleep (and yes, they knew our number) during some action that a nurse took, her neck was jarred further and my husband’s grandmother went into spinal shock.  Without our consent she was put on a ventilator and kept alive against her intentions, expressed will, every request, our request and all documentation.

Arriving at the hospital the next morning, my husband and I and her daughter spent the day trying to get the ventilator removed so that Inge could die in peace as she had always wished.  The doctor who had put her on the ventilator against her consent had “ethical issues” with letting her do as she had chosen, and as we had asked, and was in surgery and would not deal with her.  She was in a great deal of pain, and very clearly able to express her wish to let go.  Despite the fact that surgery to repair her neck injury was admittedly now impossible, despite the fact that even before she was an 80 year old woman in mixed health and there was an excellent chance she would not have survived the surgery, despite the fact that the hospital had demonstrably contributed to her condition by handling her roughly and moving her neck without support before they were certain of the extent of her injuries, despite the fact that she lacked the will and desire to live as a quadrapelegic, they felt they knew best.  I’ve rarely felt so much despair and anger at anyone as I did dealing with the hospital in this case.  I felt we’d failed her – Eric and I had promised her that this would not be the kind of death she would have.  I remember weeping hysterically in the hallway, after the fourth or fifth doctor came along to cover the legal ass of the hospital and showed absolutely no concern for Eric’s grandmother or her wishes.

Finally, after a very long, miserable day, Inge was removed from the ventilator on which she should not have been placed, and allowed to die.  She had incurred tens of thousands of dollars in medical costs, received terrible care, and was kept waiting even for death, by the estimable American medical system so many people are fighting so foolishly to keep. 

What’s notable about this story isn’t the story itself, it is that I could actually tell two or three other ones about the American medical system, but won’t, for lack of space.  I could, for example, talk about why my son, at 6 weeks old, was admitted to a hospital to be treated for a disease he did not have, and for which the only evidence was a screw up by two separate lab technicians.  In the meantime, he was tortured – he had 6 spinal taps in a matter of a few days, and we consented, because every time we questioned the doctors, we were told he would die if we took him out of the hospital, and it would be our fault.  And no, I do not exaggerate here. 

I could tell other stories, belonging to friends and family – but all of them are mostly the same – they talk about a health care system where doctors, nurses and administrators have been forced to be so fearful of a lawsuit that they run up costs beyond reason, but where competence and kindness cannot be rewarded.  I could tell more stories of long waits to see specialists (we’re always threatened with waiting – but I’ve never waiting longer in any country than the US to see people), of bankruptcies, and early deaths, and more commonly, unnecessary suffering. I could tell you terrible stories that work in every direction – of doctors driven out of practice by escalating insurance costs and huge amounts of paperwork, of patients deprived of basic medical care, of desperation.

And I can’t tell you those stories in other countries, not because there are no horror stories, not because no one in any other country has ever had a bad experience with medicine, or wanted something they could not have – but because en masse, there is no one who would choose the American system over any other rational system.  If you can name a large population from a developed country with national health care clamoring for an American style system, please, enlighten me.  Instead, what I hear overwhelmingly from across the world (and have heard for decades) is Thank G-d we don’t have American health care.

The big question, of course, is whether we can afford it.  Well, if you’ve been watching the news about Fannie Mae and Freddie Mac, you will see that they are slowly but definitely sinking into the sea, and about to create an economic crisis far greater than anything Bear Stearns or Lehmans ever could.  We will certainly spend money we can’t afford on that.  There will almost certainly be more stimulus we can’t afford.  There will certainly be more bank subsidies we can’t afford.  We are spending money in Afghanistan and Iraq we can’t afford, at huge cost to human lives and to the nation.  Our whole world is things we can’t afford.

The difference is this – a reasonable health care system actually gets us something. It will save us billions in wasted ass-covering.  It will give people access to a basic need – everyone gets sick or hurt eventually.  It will create a society of greater equity and lower suffering.  Of all the things we cannot afford, it is the only one proposed that’s really worth having.

Sharon

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

And, of course, we can see that other states are leading the way here – most notably California, which plans to resolve its budget crisis not by legalizing pot or releasing non-violent drug offenders,  by stripping benefits from children, the disabled and the elderly.  But California isn’t alone –  children’s health care is threatened or there are pushes to curtail it in nine other states, and I suspect it is only a matter of time before more states make the push to cut health care programs for children and the working poor.

Now with luck, the state budget cuts won’t matter all that much – if we can pull together a functional and meaningful national health care system.  The problem is that that’s a bigger “if” than it may seem.  Besides the endless debate about what type of national health care system to provide, there’s the very real possibility that our enormous deficits and bailouts may have made it truly impossible for us to have a system that looks like the one we have at present, and is sustainable.  Even if we can implement national health care, the question becomes whether we can sustain it over the long term, as our demographic situation shifts towards an older and sicker population, and our national economic, ecological and energy system puts us closer to crisis.  So far, as far as I can tell, most of the proposed programs for national health care do comparatively little to regulate costs, and assume levels of growth that we simply may not see.

In _Depletion and Abundance_ I included a chapter on health care – on the ways that could keep national lifespans up and spend much, much less than we do now – half as much or even less than that.  It involves a great deal of system triage and difficulty, but it is possible – and IMHO, in the end, as long as we imagine that the goal of national health insurance is not keeping infant mortality low and lifespans high, but the serving of people accustomed to a large range of drugs and interventions with as may drugs and interventions as possible, we are facing trouble.

And yet, we need national health care desperately – we already have a tiered class system in the US where those who are poor and lack health insurance get sicker, die younger and suffer more.  We already have a lifespan pathetic in the developed world – we are 44th, and lifespans are declining in many poor counties in the US.   

We need national health care because otherwise we will see that class division, and the differences in lifespans and infant mortalities between rich and poor grow and grow.  We need it because our current system is too costly and devours too many resources in every sense.  We need it because it is a basic issue of justice, and because having the crappiest medical care system in the developed world is not an honor.  We need it because we already bear the costs of medical care for the uninsured in our society, both directly and indirectly – we all pay for the poor mother who takes their daughter to the ER in the middle of the night for an ear infection that could have been handled with a ten minute  office visit.  We already pay for the people who age into Medicare with uncontrolled diabetes and high blood pressure, whose medical costs are double the costs they would have been if they’d had basic preventative care.  We already pay – the question is whether we pay honestly and directly, or inhumanely and dishonestly.

But we need national health care for another reason as well.  We need it because we need sustainable food systems, and national health insurance is the key to ensuring that we can have the Nation of Farmers we so desperately need to be.   Because one of the things preventing people from farming, one of the things small farmers off their land is the cost of medical care.

Nationally, a survey showed that farmers pay twice as much out of pocket for health care as the average American.  Most farmers large enough have to buy their health care coverage as individuals, driving up the cost, and because of the risks of farming, their premiums are higher than average.  Others have no insurance, and have to put their insurance on credit cards, or pay with their savings.  The average US farmer is nearly 60 years old, and many have pre-existing conditions that come with age – either forcing insurance costs out of reach, or driving them up.  No wonder so many of today’s farmers, when polled, say they wouldn’t want their children to follow in their footsteps – but that leaves us with the very real question of where the population that grows our food will come from.

Among younger small farmers getting started, I’ve watched many of them struggle with the insurance conundrum – they start out young and healthy, and often are willing to forgo health insurance because they truly and honestly want to do something good.  But farming pays poorly, and the first serious injury can be a disaster – and working outside all day, you get hurt sometimes.  Or perhaps they have a child – even those able to take on a homebirth find that the cost of having a child is a few thousand dollars or more – on a small household income.  Those who must have a hospital birth or more interventions can find themselves rapidly indebted.  Soon, finding a job with health care coverage starts to look awfully good – and there goes the farm, or it goes down to a part-time venture.

Farmers who experience a major injury or illness risk losing their land to bankruptcy – while losing your home is always traumatic, there’s a big difference between losing the house you love but that mostly provides shelter and a good school district, and losing the land you use to make your living.  Up to 10% of all agricultural bankruptcies are linked to illness and injuries - mostly among the uninsured.  Once the land is lost, it is gone – most farmers once out of agriculture, are out for good. 

Without a national health care system, we can become a nation of hobby farmers and victory gardeners, but that won’t resolve the grain production problem, and it won’t feed our cities.  A lot can be done by home scale agriculture, and I am an ardent proponent of it – but we need professional, full time farmers as well, and without insurance, the lure of any other work that covers the child’s asthma medication or the husband’s heart pills will always drive agriculture.  What parents wants their child to go into a profession that leads in so many ways to heartbreak and loss at so many levels – including the fact that one medical crisis is the end.

We have spent four trillion dollars bailing out the banks already, and committed another 9 trillion at last estimate.  Now whether you are a fan of big central government or not (and I’m not for many purposes), I think there can be little debate between honest people on the left and the right that the money would have been better spent serving the needs of people in need than bailing out the banks.  And we simply cannot allow our venal foolishness in subsidizing the rich to allow us to forget that we can and should take care of the basic needs of the population. 

It is certain that there will be costs and losses in whatever system arises – in _Depletion and Abundance_ I strive to acknowledge that we cannot do all the things we do at present, and that will hurt some people.  That said, however, enormous cuts could be made in the costs we incur at critical times in our lives – for example, 1/3 of all medical interventions take place in the last 3 years of life.  Some of that is inevitable – someone who gets cancer, has major interventions, but then dies two years later will fall in that category.  But an enormous number of those interventions operate simply to draw out the process of death and add to suffering – my great-aunt, visibly dying, was pressured into having open heart surgery a few months before she died, simply because no one would say “you are dying, it is time to talk about relieving your pain.”  My husband’s grandmother was pressured into giving her dying husband medications to prevent a heart attack that caused him great discomfort - at a point where a heart attack was the most benign and merciful sort of death possible. 

Even if we were simply to radically cut back our interventions at the time of death and birth – for birth too is radically overmedicalized, and many nations successfully demonstrate that the safest form of birth, barring medical complications that affect only a small percentage of the population, is home birth with a midwife – and shift our emphasis not to treating disease, but to preventing it, we could afford health care that would keep lives long and infant mortality low, that would minimize suffering and allow us to keep our farmers farming and every other useful person engaged in subsistence and cottage industry business going, doing what we desperately need – increasing the self-sufficiency of our nations, states and communities.

Few of us think of the debate on health care in terms of food security and our agriculture – but we are on the cusp of a great shift in our food system, mostly driven by demographics.  The average age of US farmers is approaching 60 years old, and there are not enough young farmers to follow them.  If we do not make it possible to go into farming a profession – if we make it only the province of the young, the healthy, the childless, we risk facing a national food crisis far more acute that the one shadowing us due to other causes.  The reality is that all of us have a real investment in our country’s continuing to produce sufficient food, and the right kind of food – and that investment requires that it be possible to become a farmer without sacrificing your health.

I do not doubt that we will struggle to afford the kind of national health care system being discussed right now.  I do not doubt that we will find ourselves at some kind of impasse at some point in the political process. I do not doubt that our spiraling debts and unfunded mandates will stress our ability to provide health insurance – but we should not believe that this means we cannot achieve health care for the masses that meets most of our basic needs.  And that we must do so.

Sharon

http://sharonastyk.com/2008/05/20/public-health-and-welfare-depletion-and-abundance-book-excerpt/

 The section focuses on the third and fourth myths of high energy medicine.  The next two suggestions will be ways we can triage the health care system – so if you think I forgot something, it might be there.  Or it might not – this is hardly all there is to say about post peak medicine, but because so far there is so little on the absolutely essential topic, my goal is to give a broad overview and a set of broad strategies. 

 One thing I don’t talk about in the book, because I’m trying to present an overview, is strategies for relocalizing drug availability.  Obviously, there are natural alternatives, but for those for whom they are not adequate, we need a better alternative than “sorry.”  I certainly on’t tend towards an apocalyptic vision in which all medicine production disappears – instead, I tend to think that ordinary human poverty will price most of us out of the drug market, the way it already does for billions of the world’s poor.  Obviously, for those who are dependent on medicine, that’s a huge problem.  But one of the fascinating things I found in my research was that some medicines – not all, but some, could probably be made in college or high school chemistry labs, if the raw ingredients were stockpiled.  Later on, I do talk about making a couple of simple antibiotics that way (and both of them have huge downsides, so this is not a way to go unless you have to).  But several research chemists I discussed this with did say that a variety of older, simple drugs could probably be made if power were available to college or even good high school labs.  This suggests that prioritizing health care and education might be even more important, and that building relations with your local chem prof or high school chem teacher might be worthwhile for some people.  It won’t fix everything, of course, there are risks involved, and many medicines are simply not reproducable on those scales.   Which again, argues for collective action and strategies to make sure that basic medications are available.

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The Costs and Benefits of Modern Medicine

In considering the second myth, the first thing we need to do is establish what gains from modern medicine we have received. Our intuitive response to modern medicine is to exaggerate our need for its input in many cases, or exaggerate its benefits compared to the alternatives. By this I mean that modern medicine and modern industrial life do enable us to treat some illnesses better than others but also cause or enable other illnesses to occur more frequently. Were we suddenly to experience a catastrophic energy shortage (something I do not view as especially likely, but will use as a model here), like that which struck Cuba during the special period of the 1990s, we would likely see some illnesses increase and others almost wholly disappear.

Among the medical concerns we would not see, or would see infrequently in a low-energy, relocalized, sustainable society, would be death and injury from car accidents. Right now, 1 million people die annually worldwide from car accidents, and another 7 million are injured or disabled. Car accidents are the leading cause of death for people under 25

Illnesses we would probably see less of in a low-energy society include all communicable illnesses, including things like flu, colds, SARS, and other airborne diseases, particularly those originating in other nations (fewer people traveling means less disease transmission). We would also experience fewer “lifestyle diseases” such as high blood pressure, heart disease, strokes and type two diabetes. All of the illnesses brought on by poor diet and sedentary lifestyle would certainly be reduced. In fact, in the aftermath of the special period in Cuba, a significant rise in lifespan was seen because of increased exercise and better diets.

We would also probably see fewer medically induced deaths. A study released by Health Grades, a private medical quality control group, suggested that in 2000, 2001, and 2002, an average of 195,000 people died from in-hospital medical errors. The study suggested that this number is double previous estimates. In addition, the hospital environment, including inappropriate use of antibiotics is responsible for the spread of “superbugs” such as MRSA, which has now escaped the hospital environment and is showing up in schools. A recent study in the Journal of the American Medical Association suggests that the US has 95,000 MRSA cases per year, of which approximately one out of five is fatal. More people die in the US from MRSA than die from HIV. Though it is probably too late to eradicate some of the superbugs already created, a lower input health care system, used less often, would create fewer opportunities for superbugs to evolve and escape into the general populace.

Over the longer term, much lower emissions of pollutants, industrial toxins and carbon would make a huge difference [ad1] in reduced levels of cancer, autism, birth defects, neurological disease, asthma and lung disease, among others. As far as I know, no one has yet run the numbers to calculate the total net gains and losses here, but I mention this mostly to observe that we pay an enormous price for our lifestyle, and yet we tend not to think of it in those terms. We tend not to think of the sudden death of a family member from a heart attack or a child’s cancer as part of the cost of our society — we tend to think of it in isolation. But when we envision change, we tend to see the full costs of that difference[ad2] .

There would be costs, in terms of lives, in a lower-energy medical system. If we anticipate that we could manage many essential treatments, but that high-input items such as elective surgery, helicopter evacuations, defibrillators in every public building and other high-energy medical investments might be less available, some people would suffer and die. There is no question of that, and it is not something that should be minimized or elided. But it is important to remember that some people who would have died in a high-energy society would not suffer and die in a lower-energy one, and that too should not be minimized or elided.

Why Health Care Should Be At the Center of Things

The third myth is the one that says that we must focus on the economy, on rail systems, on everything but health care. Underlying this assumption is the belief that if we’re headed for disaster, it is self-evident that we can’t provide universal health care. After all, we don’t have that now. But we cannot allow that to be a barrier.

Instead, I wish to make the case that we absolutely must focus our energies on health care — to the exclusion of other projects, if necessary. The national discussion on universal health care has focused so far only on creating “perfect” modern models — that is, systems where everyone can have as much unconstrained access to treatment of illness as they want. In fact, when universal health care is proposed, the notion that any kind of constraint of access might occur is the single most effective negative argument. How many times has each of us heard the claim that if we had universal national health insurance, we might have to wait for surgery?

But if we imagine a national health care service [ad3] that focuses on maintaining health (as opposed to treating sickness), on delivering basic preventive care as widely as possible, and on investing in the health care measures with the greatest possible benefits for longevity and public health at low cost, we might be able to create a model that could co-exist with any national health insurance plan and, until/unless one is created, could serve the existing needs of the 40 million Americans currently without health care. Such a system would reduce the death rate from lack of health care access (18 million people die each year because of insufficient access to health care). Right now, many insurance programs simply will not pay for preventive measures. For example, my midwife friend Kathy Breault notes that she has difficulty getting insurance reimbursement when she vaccinates for the HPV virus, which causes cervical cancers, but no difficulty getting payment for expensive tests once a patient has an abnormal pap smear.

And if we were to look more carefully at the Amish, the Cubans, the Keralans, we might find a model of health care sufficiency that is an optimization of the best of the modern and the low tech, and we might begin to make decisions more wisely about how to expend our energy and financial resources to keep people healthy.

By “sufficiency” I mean the notion, advanced by Professor Thomas Princen, that instead of seeking out market-based efficiency solutions, we might find a principle of “enough” that can be widely applied. Some Americans have far too little access to medical care, and some have far too much. The notion of restraint and optimization in health care, up to now advanced only in the service of HMO bottom lines, might be used, instead, to create an adequate health care system that might serve people’s needs, rather than market needs. What Princen calls “enoughness” seems to be a real phenomenon in health care, available to us in the light of other societies that use less health care, use it differently, and still obtain the same positive results.

The examples of Cuba and Kerala, both poor places that have elected to preserve health care and social welfare above all else, even in times of crisis, should point out what is possible for us. Going into this crisis, our society as a whole is probably going to do some things to adapt while leaving others undone. I write this book in the hope that we will have a model to work on if we are left with the burden of doing the work that governments left undone, of making do from where we are, but also in the hope that we will begin to prioritize our remaining resources as Cuba and Kerala did, even if times get very difficult. Historically, that has not been the American way — when times get hard, we ration basic needs like food, shelter and health care by price, leaving a large segment of the population’s needs unmet. But we could alter that.

Now, both Cuba and Kerala have roughly socialist economies, and it would be easy to leap to the conclusion that I am calling for socialism here or that socialism is a necessary prerequisite to providing health care in an increasingly impoverished society. Neither is true — I believe all useful economic models are hybrids of multiple philosophies, and I hold no particular allegiance to a single economic model. Moreover, I don’t believe that using government resources to tend to the well-being of one’s populace is a socialist project — any more than using government resources to support a war machine is.

If we pay taxes for any reason at all (and sometimes most of us wonder), it is that government should meet the needs of ordinary people. Right now, I think most Americans of all political stripes would agree that it is not doing so. And any analysis of health care must begin, for example, with the fact that the American military budget is twice the military budget of all other nations together, and that what we have spent on the war in Iraq would provide lavish health care many times over. Yet I’ve never met an American who thinks that the war in Iraq is a better investment than health. It seems self-evident to me that this is not a question of Marx versus Adam Smith, but a question whether government should serve the people or the government — something I think we can get an easy consensus on.

Well, Crunchy has done me one much better – she’s not only talking about menstruation, she’s making change in the world. Millions of young African women miss school because they have no menstrual supplies. Commercial makers of disposables are supplying some of them – and getting a lot of advertising credit for it, but the pads are then burnt, and the free supplies are a temporary measure, designed to create a market for disposable products many poor women and girls can ill afford. Crunchy has started a non-profit, working with aid agencies, to get women to sew or donate reusable pads to these women – and asked me if I’d help. Not only do I want to help, but I can’t say enough how much admire Crunchy’s passion – and her speed. It was less than a week before she had a project up and going.

So I strongly recommend that all of my readers read Crunchy’s posts on this matter:http://crunchychicken.blogspot.com/2008/02/last-monday-i-posted-about-how-i-was.html and http://crunchychicken.blogspot.com/2008/02/using-your-sewing-skills-for-good.html and visit her new website here: http://www.goods4girls.org/ and make a donation, either of your time or money. I will be.

You will also soon be able to donate through this site, but as you all know, I’m a techno-moron, and the addition of something as complex as a donation button to my blog is way, way beyond my skills. So I’m relying on a kind friend to help me.

And, as long as we’re talking bodily fluids here, may I also recommend that everyone think seriously about their own, as well as the menstrual needs of the world’s poor. Disposable menstrual products bite – they aren’t as pleasant or comfortable as the reusable ones, they cost tons more, and they add to landfill waste and used ones produce methane, an greenhouse gas with many times the warming power of carbon. While teenage girls may not yet be ready to carry around used pads (although it is perfectly possible to do so very discreetly), all us grownup women have no excuse.

You have a whole host of choices here – long lasting, very comfortable cups like the Keeper and the Diva Cup (I have a diva):http://www.gladrags.com/category/menstrual-cups, and various cloth pads that can be made: Note, the ppatterns Crunchy is using work well for ourselves too: http://www.goods4girls.org/2008/02/sewing-patterns.html or bought: http://www.moonpads.com/ or some other site – my own come from gladrags, and I’ve been very happy with them:http://www.gladrags.com/ but She Who Must Be Crunched has a list here:http://www.goods4girls.org/2008/02/how-to-donate.html.

While you are doing good in Africa, if you aren’t using reusable menstrual supplies, do good here, for us and the entire planet, and switch over.

And men, I don’t want to hear any whinging about this post. In fact, unless you are gay or celibate and never interact with women under 60, you should be reading this with some interest. Perhaps you have a daughter, a friend, a sister, or a wife who might be interested in this information. There are lots of women out there who might be nervous about doing this because they’ve been taught that menstruation is dirty or bad. It helps to have a husband or friend who deals matter of factly with your period, and who (if the relationship is intimate enough to allow for this) is gently encouraging (without pressure) to make the conversion.

And please, folks, donate to Crunchy’s project. It is such a little thing – and a huge thing – women’s education is enormously important for their political and social status, their reproductive future (education is tightly correlated with birthrates) and their economic and environmental security. It would be easy to underestimate how important this is. Fortunately, Crunchy hasn’t!

And next on the bodily fluids parade: the reusable condom, its engineering and the future of sperm (which isn’t actually a joke – I’ve written about this: http://casaubonsbook.blogspot.com/2006/09/hey-engineers.html)

Cheers,

Sharon