How can we cure AIDS when we can't even provide clean water

”If the solution for AIDS would be to bring a glass of clean water to everybody in the world, we would not be able to bring that. We have not been able to stop children from dying from simple diarrhea by providing clean drinking water”

Betrayal of Trust, by Laurie Garrett is an incredibly frightening book to read. It isn’t hard to be frightened by this book; I was from the very beginning and it only took those two sentences written in the introduction. Stop and really think about what it means for a moment. We are overwhelmed by crises that have been building for decades and we cannot even provide for the most basic necessities in life. it sometimes seems that there are no solutions in sight and sadly, the main line of defense, the public health system, is horribly underfunded, underappreciated and often almost non-existent.

In her book, Laurie Garrett has meticulously researched the development and the ongoing dismantling of the public health system. The book is divided into four case studies of the public health problems in four different countries: India, Zaire, Russia and the rest of the former Soviet Union and America. She also devotes a chapter the very real threat of biological terrorism. Each chapter alone is a book in itself. In fact this is a very large book. The footnotes alone take up almost two hundred pages (in extremely small type, I must add). It is literally overflowing with facts and figures. At times you feel overwhelmed by the breadth of information that is thrown at you. And none of it is pretty.

It took me a long time to get through this book. I’m usually a fast reader, but I had to slow down simply to be able to process everything I was reading. It is obvious that Laurie Garrett knows her subject extremely well and has gone to great lengths to try to explain exactly what is wrong with the public health system in the world today and the huge crisis we are facing. As a reporter for Newsweek, she has seen first hand the public health nightmares and the outbreak of diseases around the world. This book will certainly give you a very good picture of the threats that we are facing today. It certainly helps to have some background knowledge on subjects such as public health, immunology and global politics to really understand the implications, but it isn’t necessary. Coming into this book with a lack of knowledge on any of these subjects, you will still have your eyes opened very quickly.

For just a taste of this book, look at the outbreak of Ebola in Zaire back in 1995. Garrett traces the outbreak from the first person infected to it’s horrifying conclusion months later. Ebola could have easily been contained if hospitals and doctors had simple supplies such as clean gloves, latex, even water. However, Zaire’s public health system was and still is completely non-existent, since almost the entire treasury was in the pockets of Zaire’s President Mobutu. In fact, the spread of Ebola was mainly due to the non-existent hygiene at Zairoi hospitals. The hospital workers knew the problems they had. They simply had no way at all to fix them. How can you heal a person when you can’t even afford to buy something as simple as soap or even electricity?

Russia is in a complete shambles ever since the fall of communism. Much of it is due to improper and inefficient spending by the Soviet government for decades. Their public health system was a delicate house of cards that was slowly decaying and just took the slightest push to collapse. It also didn’t help that most scientists were improperly trained by the Soviets with little or no access to Western medical knowledge. Russians for years did not use proper sterilization techniques to keep down infections. They never knew about ideas as simple as “washing your hands killed germs”. They were taught that ultraviolet lights killed airborne germs and they didn’t live on any surfaces anyway, so you shouldn’t worry about that. They never learned about subjects such as Mendelian genetics, DNA and it’s importance, something that every high school senior in America understands. Instead up until the late 1970s, state mandated knowledge, developed by the Russian scientist Trofim Lysenko, taught the Russians that DNA was simply irrelevant.

“Consider this: if one asserted that chromosomes, and modern genetics, were irrelevant it would be impossible to comprehend such things as viruses, antibiotic resistance, immunology and inherited disease. Thus, Lysenko’s coterie insisted that viruses formed spontaneously our of organic matter… If viruses spontaneously arose from organic matter there need not be concern about reused syringes. Why worry about inappropriate antibiotic use or radiation exposure if chromosomes are irrelevant artifacts?”

With health care and scientific knowledge tailored to fit Soviet dogma rather than to actually help people, Russia was headed for disaster. And it wasn’t until the 1990’s that that house of cards finally fell apart. Now, Russia is facing overwhelming difficulties. Mismanagement of antibiotics have brought on drug resistant forms of tuberculosis. Lack of vaccination has brought on epidemics of diptheria and polio. AIDS has completely exploded in Russia, with HIV infecting an estimated number of 270,000 people total in Eastern Europe in 1998. However, that’s probably too low. Nobody knows the real amount because it’s almost impossible to get proper figures, especially considering the Soviet Union’s history of altering statistics to suit their purposes.

A huge majority of those cases are due to IV drug users. Drug use has also skyrocketed since the fall of communism. And the effects are also horrific. Drug users are actually shooting up opium and heroin that has been mixed with paint thinner and heroin. And there are no drug treatment centers, no outreach programs, no law enforcement, no help at all for these people. There is no money to help these people. They have no money, no jobs, no education and no hope.

In a way, it makes you feel lucky to have what you do have in America. Cause after seeing the hell that the average Russian has to live with each day, the US looks like paradise in comparison. But should we be so quick to dismiss all our own problems? We’re living in a country where over 17% of the population (and 1 out of every 4 children) has no health insurance. We’re living in a country where people have to travel to Mexico to get affordable prescription medication. We’re living in a country where people are drinking contaminated water because the microbes are becoming resistant to chlorine. We’re living in a country where people don’t seem to care that an ever increasing number of people have no access to affordable health care. And that’s just the tip of the iceberg for our problems.

Antibiotic resistant forms of TB, Staphylococcus and many other diseases are also on the rise. The main reason is because improper use of antibiotics. They are being overprescribed and the people who take them are not taking the entire prescription’s worth. As a result, instead of killing bacteria, we are simply helping them become resistant to those same antibiotics. And hospitals are breeding grounds for these bacteria. They are often, in fact, carried by the very same health care professionals who are treating us.

by 1997, 10 percent of all patients who spent more than one night in the average U.S. hospital acquired a nonviral infection nonsocomially … In intensive care units the odds that any given patient would be infected in this way approached fifty-fifty. And all too often these infections were fatal.

That’s not a very pleasant possibility to think about the next time you have to stay in a hospital. And unfortunately, there’s nothing we can do other than slow down antibiotic use in order to lengthen it’s usefulness. Meanwhile, we need to find another method of treating these diseases and hope it comes in time.

So, what can we do? I admit, at times, the situation seems hopeless. In some ways, problems are inevitable. And disease certainly is, since it is constantly evolving in new ways in order to survive. We have been at war for generations and we will for even longer. We can only hope that are actions don’t make things worse. But there are some things we can do to slow the tide and sometimes to even change things for the better. Simple things like clean drinking water, safe food and proper sanitation are absolute necessities. And we need to be more vigilant to make sure that people have access to all. Just those three things can make a dramatic impact. Vaccination is extremely important. In order for a vaccine to successfully work and prevent epidemics from reoccurring, at least 90 percent of the population needs to be vaccinated. People need access to basic health care. It’s a controversial subject at times, especially in this age where any type of government sponsored health care is looked on as evil. But health care is a necessity.

In this age of amazing scientific discoveries, we often get so caught up in the discovery of the moment that we forget about the basics. After all, the human genome project is certainly much more interesting than looking for E. coli bacteria in foods. And it certainly pays better. So, public health gets lost in the shuffle. Unfortunately, it’s not until we’re in the middle of a crisis that we realize how much we should have paid attention to it all along. Maybe this book will open your eyes to it a little bit, too…