For the record, I’ve never claimed to be smart. Heck, I’m convinced that getting into the most prestigious public health school in the world is a fluke, more the result of inspiration and guidance from some very smart people than from my actual achievements. Some people tell me that I’m suffering from “impostor syndrome,” but I’m pretty sure I’m the dumbest person walking those halls… The dunce amongst the nerds.
Upon seeing a picture of the places where I went the other day, and reading the story of the mother with the special needs child, a brilliant friend of mine and fellow student at the school asked something that has had me thinking. He asked if the woman having mosquitoes in her house was a result of her ignorance or her poverty, or both. This made me think about it a lot because it speaks to the kind of interventions needed to keep Chikungunya at bay here and in other places in the world. (And not just Chikungunya. There are plenty of other vector-borne diseases.)
If it’s her poverty, then the solution would be to provide her with the resources needed to install screens on her windows and doors, air conditioning so they don’t have to open windows to cool the home, and running water in enough supply so she doesn’t have to keep it in open containers. How that assistance would be delivered is for a whole other blog post. But would that be enough?
If it’s her ignorance of the entomology of mosquitoes and the epidemiology of vector-borne diseases, then the solution would be to tell her to cover any water containers, add clorox to the water, and properly scrub containers when she cleans them out. She would also be given information on identifying mosquito larvae and the different species of mosquitoes and the diseases they carry. Of course, she would be educated on other health things that she could combat at home.
The third inevitable cause is that there is a combination of things contributing to the larvae in the household. But to know how each contributor does its thing would require some sort of a study. (Though I’m very sure that there is some knowledge out there on this… I just don’t have the internet bandwidth to go searching for it right now.)
This, ladies and gentlemen, is the everlasting tension in public health policy. On the one hand, you have people who say it’s the resources. On the other, you have those who say it’s the knowledge. You may also have some people who say that it’s the woman’s own fault for not seeking out the knowledge, or not having a good-paying job, or some such nonsense. And others, also on the extreme, will blame the whole of society for not stopping what they’re doing and coming to the woman’s aid.
But I like to stick with reality.
We are arriving at an age where information will travel from point A in the world to B in another part of the world in an instant. Cellular telephones, which are more computers and less telephones nowadays, will allow people of different social strata to all communicate and have access to information. It has to be the right information, though. The worst thing that could happen in the case of the woman in question would be for her to subscribe to the idea that Germ Theory is false.
Delivering that kind of information to the hands of every person in the world is a problem of both resources and knowledge. You have to have the resources to deliver the vehicle that will transfer the information, and then you have to deliver the right kind of information to confer the most knowledge. How to do it is, again, something for a later blog post.
Of course, there are likely consequences to all this. Mess with the balance of resources and information/knowledge, and you can have worse consequences than you started off with. Just look at all the people who do “their own research” online. Or deliver the right knowledge without resources and the intervention is useless. Then there are matters of lifestyle and social pressures.
These are the things that keep me up at 3am on a Thursday night in Barranquilla, Colombia.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.