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| Summer Series Part I - Floods and Disease |
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by Bob Blumm, MA, PA-C, DFAAPA - July 15, 2011
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We have been eye witnesses to devastation and destruction as well as volunteerism caused internationally in the past few years by floods, earthquakes, volcanoes and tsunamis to name just a few. Each night, our television displays scenes of people in utter despair as everything that they have saved for and worked for has fallen prey to natural disasters. Sometimes I think that we have become oblivious to these situations due to their frequency and to 24 hour media coverage. But what if---this were our city or state or country, what if this were our small town, hospitals and homes, what if this were our family members to whom we never had the chance to say goodbye? Sometimes we are like combatants who are heartbroken as they look at a fallen comrade, a fellow patriot but also are grateful inwardly because it was not us.
Disasters such as we have seen around the world have left in its aftermath flooding, breeding places that become like a petrie dish and rampant disease ensues which affect the inhabitants as well as the volunteers, whether they be the military, world health organizations , and our fellow NPs and PAs who are answering the call of those in great need.
I read an article five years ago where the author stated that 70%of the 50 million people who travel to developing countries each year return with some type of illness. When we are part of a medical team going to a disaster area, we are not sleeping in the local Ritz Carlton nor are we dining in five star restaurants. Our living conditions are somewhat similar to the local population; we are susceptible to all of their current potential maladies. Our activities are far riskier as we are dealing with the sick people; we need to practice meticulous infection control measures and be immunized prior to leaving the continental United States. Not unlike in a war, waving our Red Cross flag will not protect us but rather make us greater targets. I choose to pick one disease and will find time to touch on others this summer.
Leptospirocis is not a common disease found in every family practice office in the North East but is endemic worldwide. Its incidence is much higher in tropical climates and we find this bacterial zoonosis in the canals that have formed in streets that were once used by cars, trucks and humans who chose driving or walking as a means of transportation. Infections for health care workers often occur because of a break in the skin, mucus membrane exposure or from drinking contaminated water from unauthorized water supplies. It is also note worthy that these problems can exist in our southern states that have been rampaged by swelling rivers which have invaded lands that usually only sustain rain . Rescue efforts in these areas require investigation by team leaders with the CDC to discover if diseases have been reported.
As with other diseases, we need to ask ourselves what the presenting symptoms are. We know that the signs and symptoms have a differential diagnosis; they include headaches, diarrhea, fever, nausea and myalgia. There are optical complications that will also present, which means a referral to ophthalmology when we are confused with the diagnosis of an eye disease. When considering more serious diseases, please do not forget jaundice, uveitus, aseptic meningitis, jaundice and renal failure. Early treatment should be initiated and correspond to CDC guidelines but amoxicillin, penicillin and doxycline have been used in the past. The CDC recommends treatment prophylaxis 48 hours prior to entering endemic areas when possible.
Infectious diseases have plagued mankind since the beginning of civilization and we have learned through many cultures that religious practices, such as quarantine, are valuable as is covering of the face and mouth with a mask and the judicious use of soapy water and/or gloves. Some diseases traditionally required burning of the host or all clothing and created increased famine, a shortage of workers in the fields, crop failure. Sometimes, the premonition of death caused an acceleration of immoral behavior, as the philosophy during the Black Plague was eat drink and be merry for tomorrow, we all die. Even moderns suffer terrible trauma on a variety of levels when faced with disease and potential death. As professionals we need to infuse hope, offer support, be prepared for any number of emotional responses. We must also employ proper methods of field sanitation to change the destiny of inhabitants in areas prone to diseases from flood and associated illness.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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