On mumps and medicine

Perhaps it's due to my family's involvement with public health medicine or maybe it's just a wise thing to stay tuned into, but regardless, public health is a great interest of mine. Unfortunately, it's probably because I'm sick far more often here in Macedonia than in the US, and thus I've always pondered and fretted about my and other people's health here. When I was a Peace Corps volunteer I used to regularly clean a greenish-white sludge out of my PC distributed water distillation system. While I drank the water that came from it, I always worried what I was drinking when I was at school, in a cafe, or someone's home. Things are no different here in Skopje, and as a result I spend $20/month buying spring water from the mountains in 6 liter jugs that I pick up at the grocery near my school. I consider lugging those things up four flights of stairs well worth it.

The unfortunate thing is that a lack of general concern and action over public infrastructure and health characterize this country. We sporadically hear about the increasing number of miscarriages, cancer, infections in hospitals, and less severe situations, but little is done to investigate them.

Fortunately, there are people interested in changing this, and I've begun working with them at an organization here in Skopje. Unfortunately, two incidents in just as many weeks are at the fore of my mind in reminding me of the acute situation in Macedonia that could result in disease transmission at best, and a major epidemic at worst.

The two events I'm referring to are my own illness last week, how and where I was treated, and the outbreak of mumps in high schools throughout the country this week.

Personally, I fell ill last week with a vicious stomach virus. I lost an incredible amount of bodily fluids and thus went to the state hospital here for medical attention. Not only was I mis-diagnosed (the doctor wanted me to get an x-ray for possible bronchitis) but I was attemptedly ripped-off (but fled before paying!) for being American, and frightened that I might have picked up something else in the waiting room of the clinic. For it was filled to capacity with ill people who were waiting and waiting for attention. Perhaps they all got what they needed, using their government issued pink slips to cover their medical needs (it is still a nationalized medical system here), but I'd gather that some did not. That I do not know.

What I do know is that my brother-in-law, who is an oral surgeon resident at the hospital, informed me that the disposal of medical instruments--primarily needles and syringes--is totally out of line with health regulations. Used and infected bandages, needles and the like are mixed together, and while some are kept isolated and destroyed in a secure location, others are merely put in the dumpsters for stray dogs and cats to go through. Stray animal management (and lack of it) is a whole other story in itself, but unfortunately these creatures can act as agents of transmission--vectors--to their and our species' populations. I also know that in my wife's hometown all medical supplies are thrown in with the town garbage, driven 5km outside of town (but upwind from it) and burned. Yes, rubber gloves, syringes, plastic bottles and bags, and all other refuse are pushed daily into a giant furnace, their smoke then floating over the town and into the valley below.

But back to my illness, I suppose I shouldn't bite the hand that fed (or in this case, healed) me, as I was fortunate to be able to head to that small town's hospital for immediate treatment last week--getting an IV put in to rehydrate myself. I recovered after many days of weakness, taking an antibiotic (though having had a virus, I don't know if it was so wise for me to have been given such a medication...), and on a lighter note--the doctor insisting that I just drink herb tea. Lots of it, hot or cold! Oh yes, and I had to eat dry crackers dipped in said tea as well. An odd and rather unpleasant combination...

Unfortunately (I'm using this word a lot, I know), what's occurred this week in Macedonia, a European country, is more indicative of corruption and a serious lack of effective healthcare policy at the national level: there has been a mump's outbreak. Right, you're thinking "Mumps? Don't we get vaccinated for that when we're tiny tots? What the heck is it anyway??" Well, yes, we do get vaccinated and they should be here as well. Unfortunately, from 1990-94 (and that's for the current outbreak's age range) they didn't and thus this week in high schools across the country hundreds of cases of the highly contagious, greatly unpleasant illness have arisen. Teens necks have swollen and all they can do is suffer from the pain and hope it recedes soon, as there is no real cure for mumps.

Fortunately, mumps doesn't kill, but it can cause permanent damage (particularly to males' reproductive systems). What's worse is that the government is now on a mission to vaccinate all students again, so that the evening news is filled with images of public health workers injecting students with vaccines. Anyone who knows a thing about biology, vaccines, and the human body, however, might know that this could be a potentially catastrophic remedy. Injecting a vaccine--which is a deactivated version of an infectious virus--into someone's body where a live virus may be harbored but still dormant, can potentially activate the latter and lead to infection. Mumps epidemic is one thing, but what if it was a virulent flu, measles, or other virus? Would the government act the same way?

One thing I do know that further illustrates the government's image vs. reality is that they have touted their implementing the administration of the HPV vaccine for teenage girls. Realistically though, they only purchased a few thousand of these vaccines for a female teenage population of tens of thousands, and thus the vaccine is not as available as it might seem. The organization with whom I work has raised this issue, and my brother-in-law has confirmed that only the connected can get the HPV vaccine.

It is just a shame that the country's and region's public health is being compromised by greedy and selfish individuals who seek to profit at the expense of other people's health. Maybe this week's outbreak and other such issues will be brought forth in next month's presidential and municipal elections, and act as a catalyst for change, but I'm not optimistic.