A note for online readers: As I write this, I am recovering from a systemic fungus infection that covered my entire body with a damnably itchy red rash severe enough that my physician spontaneously exclaimed in surprise when he saw it. Pockets lighter by over twelve thousand vatu (about USD 120), I am now burdened with three different medications and six more weeks of treatment before I have any assurance it won’t recur. My friend Ruth informs me that her entire community is rife with the same condition. I do not, however, have enough money to treat even one of them. They’ll have to content themselves with rubbing their bodies down with bush limes, not a pleasant undertaking, to say the least.
At the same time, my brother’s daughter (and my namesake) has only just recovered from a nasty infestation of boils all over her forehead. I can’t describe the poor child’s misery. Her father has been kept from work for over a week now with one of these nasty putrescences in his armpit. It’s so painful that he’s been walking around with his hand permanently poised against his hip like a lawn jockey. The elderly man he’s hired to look after the family kava bar has one foot rendered nearly useless by chronic infection, and his eldest boy has a permanently misshapen thigh bone, fractured by a subcutaneous abscess that was never properly diagnosed or treated.
The list goes on.
Remediating problems like these is not simply a medical issue. The causes are environmental and infrastructural in nature. There is currently little awareness – and no comprehensive statistical measurement – of the extent of the damage to society by afflictions that are simply not tolerated in developed areas. I say ‘areas’ because such problems are utterly unknown in the wealthier parts of town.
So now you know what motivated me to write the following in this week’s Weekender edition of the Vanuatu Daily Post….
Let any man who thinks humanity resides at the apex of evolution come and live in the tropics for a year or two. It won’t take long for him to realise that in warmer countries, the average human being is nothing more than an elaborately conceived buffet for a multitude of creatures too small to see.
God may love all creatures great and small, but sometimes I’m tempted to believe he likes the small ones better. I could recite a laundry list of different little creatures I’ve played host to in my years here. From tiny viruses, bacteria and single-celled plasmids to fungi and molds on up the chain to mites, ticks and worms, insects without number… I give myself the willies just thinking about them.
I suspect it’s no accident that ‘paradise’ and ‘parasite’ are so easy to mix up on the page.
Some of the afflictions these islands visit on their inhabitants are truly ghastly. One of the most shocking images conjured up by James A. Michener – lionised for his Gauguin-esque rendition of the tropical idyll, but more memorable in my mind for his willingness to honestly enumerate all aspects of life of in the Pacific – is of an old villager:
“Moving from the jungle was a native with elephantiasis . . . pushing a rude wheelbarrow before him. In the barrow rested his scrotum, a monstrous growth that . . . weighed more than 70 pounds and tied him a prisoner to his barrow.”
I found that Michener quote in a Time Magazine article written in 1962. After this startling introduction, it triumphantly announces the eradication of filariasis in parts of the South Pacific. A full two generations later, Vanuatu finally vindicated that celebration with a ‘final’ anti-filariasis drive.
I put ‘final’ in inverted commas because I recall being told by a public health practitioner at the time that this particular drive was not the first ‘final’ push to eliminate the terrible – and altogether preventable – disease.
Treating illness in the tropics is necessarily a tougher prospect than elsewhere in the world. First, the climate does make it a parasite –er, paradise for God’s tiniest creatures. And maintaining basic public health infrastructure can be a daunting challenge. Sometimes an issue as simple as refrigeration is enough to stop work dead in its tracks.
Diane Bennett, Director of the US-based Development Research Institute, tells a heart-breaking tale of watching thousands of Sudanese children die of measles because her NGO didn’t have a refrigerator in which to store the vaccine. She and her colleagues moved mountains to try to obtain the support necessary to keep one in operation, but after seven years, they still had none. For want of a fridge, thousands of lives were lost.
Vanuatu is more fortunate in this particular regard. While our medical services are in short supply, rudimentary and unreliable at best in the islands, we do at least have a functioning medical evacuation system for gravely ill children and adults. In contrast to the Sudan, at least our children stand a chance.
But there’s more to medicine than saving lives.
Something I find truly galling in Port Vila is seeing chronic, preventable conditions exacerbating the larger health threats and creating a largely un-measured drag on the national economy. The number of people suffering from boils, skin ulcers and other opportunistic infections is startlingly high. When I visit my adoptive family during the warmer months, inevitably at least one of them is so afflicted. More often than not though, most of them are.
The fevers, pain and loss of sleep brought on by these have cost more than a few days lost to illness. But equally important is their impact on the quality of life.
These afflictions are largely unheard of among those who don’t wander much into Vila’s residential neighbourhoods. That’s because they don’t have to cope with lack of sanitation, dirt floors, mud, overcrowding, inadequate or non-existent drainage, lack of proper screens and countless other shortcomings that the average resident copes with daily.
Public health relates directly to public wealth. And the equation runs both ways: If we improve public health, we improve productivity. Improving productivity improves living conditions, which improves public health. Ultimately, it allows us to move beyond spending all our health dollars doling out medication to endless queues of children, women and men.
So where to start? The answer is simple. Cement floors.
I’ve said it before, but it bears repeating – we need to begin a campaign to make cement available at affordable prices to those living in our most marginal communities, especially Blacksands, Freswota 4 & 5, Ohlen and Manples Mango. This single, relatively affordable measure would improve conditions immeasurably for everyone.
This isn’t charity I’m talking about. A small-loan scheme based on the improved equity of the properties involved is one approach that could achieve great things for countless ni-Vanuatu households.
But in order to develop the will to start, we need to recognise that taking ourselves off the microbial buffet menu requires more than medicine. Tropical climate notwithstanding, our afflictions are largely our own.