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Friday, April 12, 2013

A Community Conversation - Part 3

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Part 3:  Individual Power in Community Health Dynamics

Nothing in healthcare is simple.  We have a limited understanding of the human immune system.  The study of the human biome is in its infancy.  Vaccine science is imperfect.  Microbes keep evolving and antibiotic effectiveness is plummeting.  Feel powerless yet?   

Actually, we have a lot of power.  Small decisions matter.  We have the power to protect the community.  When it comes to contagious diseases the moment of power can come when we wake up with cold symptoms and face the hard decision of whether to go to work...or stay home and take care of ourselves.

We live in a society that values tenacity and often regards self-care as weakness.  Stepping back from obligations can be viewed as inconsiderate.  Perhaps it is time to challenge these values?
Challenging an entrenched social value is always easier with good tools.  These 6 steps illustrate a new way of approaching our role in community health care.

Step 1:  Take care of yourself
Many pathogens are opportunistic. If your immune system is in poor shape, you are more likely to catch something nasty and more likely to spread it through the community. Start with the basics. Get enough sleep, get enough exercise, eat good food, drink enough water, get medical care as appropriate.

Step 2:  Body awareness
Early signs of illness can be very subtle. Unfortunately, this is often the time when you are most contagious. Learn to notice that you are ill before you are flat in bed with a fever of 103. Aside from the community benefits, caring for yourself early may shorten the duration of the illness and return you to full health more quickly.

Step 3: Observation
When a lot of people are sick with similar symptoms, it's probably the same pathogen. If you've been hanging out with these folks, you have probably been exposed. Now is a great time to take extra good care of your health. A strong immune system can't prevent all illness, but it usually helps. Remember that in certain cases you can be a disease carrier even if you don't have any symptoms. 

Step 4:  Research!  
When researching, look for the incubation period, contagious period, normal progression of the disease, possible complications, treatment, testing, and high-risk populations.

Step 5:  Minimize contact 
If you have symptoms, assume you are contagious unless you have medical evidence to the contrary. If you've been heavily exposed to an illness, consider the possibility that you might be an asymptomatic carrier. This means you can be contagious even if you have no noticeable symptoms. Take reasonable precautions based upon the illness to which you've been exposed. This might be anything from washing your hands a lot to putting yourself in full quarantine. Be especially aware of vulnerable populations like tiny babies, pregnant women, immunocompromised individuals, and frail elders.

Step 6: Support others
There are many forces in society that pressure people to “keep going” despite being sick. Try not to be one of these forces. Encourage employees, volunteers, students, and clients to stay home and rest when ill. Offer to pick up groceries for a sick friend. Take whatever actions you can, large or small, to support people in making responsible choices.

Of course...sometimes we get lucky and get specific information about the disease that is circulating. Suppose you get a memo from your school or workplace that several people have been diagnosed with pertussis. How would you apply the above process?

Step 1:  Research
You are lucky!  You know what you’re dealing you can start with research.  You will discover that pertussis is annoying for most healthy adults, terrifying for people with health challenges, and potentially fatal for infants.  It would also be useful to gain a realistic understanding of the potential benefits and failures of the vaccine, the accuracy of available tests, the likelihood of an inaccurate diagnosis, and the fact that over 50% of adult pertussis cases never have the characteristic "whooping" cough.  In fact, some people can be entirely asymptomatic carriers.  It would be useful to know that antibiotics can be helpful, but only if given early.  You also might like to know that up to 30% of pertussis cases are actually caused by parapertussis, for which we have no vaccine.  All of these details are important if you are to take effective steps to protect yourself and the community.

Step 2: Take Care of Yourself
Evaluate your own risk factors.  Apply what you learned in Step 1 to your unique situation.  Respect the disease and respond accordingly.

Step 3: Body Awareness
The first signs of pertussis are trivial and look just like a cold or even allergies. A runny nose, nasal congestion, sneezing, red and watery eyes, a mild fever, and a dry cough are the classic symptoms of early pertussis.  Notice them.  If you have a known exposure to a specific case of pertussis, assume you have pertussis.  Otherwise, track your symptoms on your calendar to see if they match the patterns of pertussis. Keep your health provider informed, and err on the side of caution.  Your mild case can give a deadly case to another person.  Respect the disease.

Step 4:  Observation
In this scenario, someone told you that pertussis is circulating in your community. But you won't always get a memo. If you notice a steadily growing population of people who have an odd cold that lingers for months, pay attention. It could be pertussis.

Step 5: Minimize Contact
When you have a known exposure to pertussis, stay away from newborn babies and pregnant women in their third trimester.  This is true whether or not you have developed symptoms.  People who have been vaccinated against pertussis must be especially alert, since the protective effect of the vaccine increases the likelihood of them becoming an asymptomatic carrier.

Step 6: Support Others
Encourage others to openly discuss the complexities of this disease. Support the use of masks, working from home, taking time off, visiting the doctor, and other forms of self-care. Most importantly, remind everyone to keep all coughs away from newborns and anyone in close contact with newborns.

There are many powerful tools available to us in our quest for personal and community health. These six steps are a good start. By using them, we can help limit the spread of communicable disease and protect the most vulnerable. In the case of pertussis, we can even save a life.

“A Community Conversation About Health and Responsibility: Vaccines and Beyond” is an ongoing series written by two close friends with a passion for improving community cohesion and building respectful relationships in a diverse world.  This article was co-created by Karen Crisalli Winter and March Twisdale.  BLOG:   Email:  

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Welcome to the conversation. Knowledge changes. People respond best when this truism is kept in mind. In community, March & Karen