The Emperor’s New PPE

By Sally Sellers

SallyAnnSellersSally Speak is the effort of Sally Ann Sellers, RN, BSN, MA Ed, an old battle-ax who is just delusional enough to think her pen is mightier than a sword. Good night & good luck!

“There is no greater evil than men’s failure to consult and to consider.” ― Sophocles, Antigone

Hospitals in the US cause about 400,000 premature patient deaths each year due to preventable harm (iatrogenic causes). This equates to three jumbo jets falling out of the sky each day (James, 2013). Our dysfunctional healthcare system tolerates the carnage of preventable patient injury and death, and potential occupationally-acquired infectious diseases by healthcare workers (HCW). But with the introduction of Ebola Virus Disease (EVD), we may be creating unsafe conditions that threaten communities outside of the hospital walls if our isolation protocols and personal protective equipment (PPE) do not work properly. This deadly problem may add to the list of poor outcomes of our healthcare system, spreading the disease, since caregivers are vulnerable to being infected and carrying it into communities. In West Africa, as of mid-October, WHO reports 420 HCW cases of EVD, and 239 deaths, and 2 HCW cases in the US and 1 in Spain.

The deadly outbreak of EVD has created the need for change within the U.S. healthcare system, but the leadership at the CDC and other healthcare in-groups are reacting slowly, with groupthink, creating a situation where those who set policies actively suppress dissenting viewpoints, isolating themselves from outside influences and even taking irrational stances that dehumanize other outside groups, such as “sloppy nurses” and a “panicky public.” When groups make faulty decisions that lead to a deterioration of mental efficiency, reality-testing or moral judgment, they are displaying symptoms of “Groupthink”, a term coined by social psychologist Irving Janis in 1972. What are the signs of groupthink, and how do those signs present during a crisis when we need to change healthcare standards and policies?
Continue reading The Emperor’s New PPE

Clutching our world views with a death grip

By Mary Odum

As I write, I am sitting in what might be my last airplane seat, stacked cheek to jowl with a couple with a cute but runny-nosed baby. My trip was with girlfriends on a bike tour in California, and I made the most of it, living very much in the moment. As I traveled, I wore my infection control hat, scanning the settings with new eyes for potentially dangerous situations. I was careful in public places such as airports, trolleys, and the BART, washing my hands frequently and keeping them folded in front of me. I was much more aware of impulses to touch my face. I watched a couple in the San Francisco airport who were headed to Nairobi touch their faces, many times, as they waited. Airport bathrooms were mostly hands-free, but the automatic toilets sprayed their contents powerfully in all directions when flushed. There was a new sign in the TSA line warning us to wash our hands because of Middle East Respiratory Syndrome (MERS), but no mention of Ebola (EVD). TSA used gloves to pat me down, but they were not washing their hands after contact with people. Boarding passes, drivers licenses, and credit cards were swiped and exchanged, along with bills and coins. I saw a large homeless population on the waterfront in San Francisco with no access to bathrooms or handwashing, who were using the streets as open latrines. I saw prostitutes. Hotels had carpets and mattresses that would defy cleaning in an outbreak. I saw people hugging, and shaking hands, and doing all kinds of human, caring, or even loving things that would be extinguished in a pandemic.

Today the first nurse within the US healthcare system has acquired EVD. My nursing friends are worried. Are we ready for this? How do we communicate risk, or should we settle for optimistic reassurance that our system can handle this? What are our biggest needs in preparation?
Continue reading Clutching our world views with a death grip

Uncharted territory for a system in overshoot

By Mary Odum

http-:www.flu.gov:planning-preparedness:community:community_mitigation.pdf-fig3a
http-:www.flu.gov:planning-preparedness:community:community_mitigation.pdf 1918 pandemic CFR = <3%. Where would Ebola’s CFR line be on this graph?

We are in uncharted territory with the Ebola virus disease (EVD). The last time we had a plague that was this deadly was the Black Death in the 14th century, when there were only 450 million people in the world. That pandemic killed 30% to 70% of the population. There is no benchmark for EVD, which kills 3 out of 4 people it touches, and is emerging into a global population of 7 billion.

Ulgiati et al., 2011, Emergy-based complexity measures in natural and social systems - Emergy flows plateau in modern Rome as an example of a high-transformity system
(Ulgiati, Ascione, Zucaro & Campanella, 2011, Fig. 1) Emergy-based complexity measures in natural and social systems – Emergy flows plateau in modern Rome as an example of a high-transformity system

This pandemic signifies a turning point for society in response to peak oil, highlighting the problem of globalization for a planet of 7 billion people. We have lost control of a deadly outbreak, and our responses to its exponential growth are linear at best, ensuring that this plague will most likely spread further. Many in first world countries think we are immune to plagues. How might transmission of EVD change as it moves from a low-resource or low-transformity setting in West Africa to resource-rich (high-transformity) countries?  How might the battle against this epidemic change as it breaks out into different environments?

Continue reading Uncharted territory for a system in overshoot

The 4S’s of surge capacity

By Mary Odum

Welcome to the arcane and short-sighted world of public health strategic planning. This post introduces the term surge capacity, a term we will hear often in the coming months of this growing Ebola (EVD) epidemic. Surge capacity is the ability to manage sudden or prolonged increases in overall healthcare demand, and the key components are the 4 S’s of staff, stuff, structure and systems, for hospital and community preparedness (Adams, 2009). During a pandemic, lack of surge capacity in all four of these areas become key limiting factors:  hospital isolation beds (structure), healthcare providers (HCP-staff), isolation gear (stuff), and an efficient, just-in-time, high-transformity system, which is an obstacle to resilience.  Continue reading The 4S’s of surge capacity

Ebola as a game-changer?

By Mary Odum

In crises, anxiety focuses attention. I continue to focus on the growing Ebola epidemic, which has no real restraints to keep it from becoming a global pandemic. Overpopulation, inequity, peak oil, and disturbed natural environment have converged with the problem of Ebola, to set up the conditions for a pandemic. If we add a slow response from complacent, frozen bureaucracies to this toxic mix, then we can expect a global pandemic to occur. We have met the enemy, and he is us.

Healthcare professionals need to speak up about healthcare inequity and US readiness for pandemics. And I have a particular interest in this topic, since I am potentially most exposed as a nurse to acquiring Ebola through patients shedding the virus in body fluids, and women are at high risk as typical care givers in the home and hospital. I have studied handwashing in hospital settings, with insight as to the gaps. So I will continue to perseverate here, and add my nursing voice to the choir of concerned healthcare professionals. Continue reading Ebola as a game-changer?

A review of Barry’s “The Great Influenza”

By Mary Odum

BarryCoverThis week I finally read John M. Barry’s 2004 book, The Great Influenza: The story of the deadliest pandemic in history. Barry explains the lessons that we should have learned from the Great “Spanish” influenza pandemic of 1918. The book is well written, albeit with a lengthy introduction of the medical researchers and their personalities. If you don’t enjoy the history of Medicine or details of early virology research, you can skip that part. In his afterword, Barry states that a future pandemic is certain to occur, and we are in no way ready for it. Since my PhD is in Nursing-Health Policy, this is a topic that interests and worries me greatly, so I will expand on my earlier post as this threat has continued to expand and evolve. This post serves as book review and comparison of similarities and differences between the Great Influenza pandemic and the current looming threat of another pandemic, Ebola (EBOV). Continue reading A review of Barry’s “The Great Influenza”

Stop growing or meet the four horsemen?

By Mary Odum

I took some time off from writing this summer, as I was busy getting unmarried and moving back to my original home, Florida. Don’t ever change your name—it’s a real hassle to change it back, from Logan to Odum. The divorce was quite amicable, after almost 40 years together, and Alaska provides few obstacles to the process. The house in Alaska sold quickly, to friends, so here I am, literally a hot mess, in north-central Florida, trying to re-acclimate to 92 degrees in the shade with 95% humidity. Instead of wolverines and bears traipsing through the yard, it is raccoons and possums. Instead of goshawks eating the chickens, I have fledgling cardinals at my feeder. And instead of glorious mountain tundra runs, I have quiet paddles along sacred springs and lakes. I have encountered enough old friends and acquaintances here that I am quickly regaining my sense of place in this sunny, hot, subtropical, watery paradise. Continue reading Stop growing or meet the four horsemen?

Go LOW for health and sustainability

by Jessica Njaa

After enduring a medical issue, Jessica Njaa became increasingly interested in researching how food affects health, and the environmental aspect of food choices. She is an Honors student at the University of Alaska Anchorage, and is currently pursuing a Bachelors of Science in Environment & Society.

sadnessMost Americans are suffering from SAD– the Standard American Diet. This diet consists of highly processed, mass-produced foods grown with unsustainable practices. Processed foods generally have lowered nutritional quality and are usually not organic. Eating such foods increases the risk of a multitude of health problems. The diet is not sustainable, with a large footprint and energy basis. We are beginning to understand as a society that we have a major impact on the environment, and are using energy and fossil fuels in an unsustainable way. So what are the solutions? We have the power to make the change by Going LOW!

What are LOW foods? LOW foods are Local, Organic, Whole, and Low on the food chain. To GoLOW is to change the diet to include eating LOW foods for health and environmental sustainability. Continue reading Go LOW for health and sustainability

Adding and removing complexity

By Mary Logan

An article on the difficulty of building truly green buildings and recent discussions about the healthcare system triggered thoughts about a major transition problem that is occurring over and over again—the problem of a complex hierarchy that demands feeding with extra energy. Previous posts about the added complexity that digitization brings are pertinent here, but this post is about the general problem of how we respond to limits by adding complexity, and what it might take to remove complexity at the top of the hierarchy without collapse. Continue reading Adding and removing complexity

Lies, damn lies, and radiation health

by Mary Logan

Recent news about Hanford leaks, a flurry of news surrounding the two-year anniversary of Fukushima, and today’s news about breast cancer rates in the US center my thoughts on blind spots in health research. I will use ionizing radiation again as an illustration of environmental linkages to disease, beginning with the trigger for this post, which was a new World Health Organization (WHO) report. Previous posts about nuclear hazards are linked here and here.

This week, the WHO published a preemptive report on Fukushima, only two years after the disaster. The WHO concluded that “for the general population inside and outside of Japan, the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.” This conclusion is from the same organization that has been muzzled on the topic of ionizing radiation contamination of our environment since 1959, when they agreed to misinform the public in subordination to the global nuclear governing body, the IAEA, to protect civil and military nuclear interests.  If you believe that Fukushima has not increased background risk and there will be no increases in cancer rates, I have a bridge to sell you. Mark Twain’s maxim about lies, damn lies, and statistics can be applied here. The point of this post is to examine western medicine’s epistemology of disease, specifically examining how we select the risk factors that are involved in cancer and other diseases.  Continue reading Lies, damn lies, and radiation health

Slapping bandaids on empire’s heart attack

Slapping bandaids on empire’s heart attack

by Mary Logan

“Before you get too exercised over the multiple idiocies and injustices of the current American medical situation just reflect for a moment that the whole creaking system cannot possibly survive no matter what the Supreme Court might have ruled or whatever Obama sought to accomplish. The US economic system is about to blow up. The banking sector has been kept technically alive on the life-support of accounting fraud since 2008, but that artful racket is coming to an end because sooner or later the abstraction called “money” must make truthful representations of itself in relation to reality, or else people cease to accept its claims of value. Without a functioning banking system none of the rackets organized into US health care can continue” (JH Kunstler, July 2, 2012).

Kunstler has succinctly summed up the big picture for American healthcare. We are slapping bandaids on empire’s heart attack. I am revisiting healthcare reform for two reasons. First, healthcare’s complexity creates a good exercise in broadening our scale of view. Secondly, now that healthcare reform is law, the question is, what does this new law mean for individuals at the small scale, and for the country at the larger national scale? Continue reading Slapping bandaids on empire’s heart attack

Laying Siege to Empire; Big Pharma Edition

by Mary Logan

Before we leave the subject of health policy, I would be remiss if I didn’t take an equal opportunity swipe at the big pharmaceutical companies in the United States as some of the biggest profit-makers in healthcare. To quote a commenter from last week’s post on Healthcare for All in the US, our healthcare system is a nightmare. This companion piece exposes our mental models regarding the subsystem of the pharmaceutical industry in the United States as a component of the most expensive healthcare system in the world. Big Pharma has managed to capture feedback loops in order to control the drug-making, approval, and marketing process so thoroughly that the physicians, the regulators, and the insurance industry all appear to be dancing to the rhythm that Big Pharma sets as a primary producer who generates much of the supply for the wellness factory in the United States. Continue reading Laying Siege to Empire; Big Pharma Edition

Healthcare for All in the U.S?

oldamericancentury.org

by Mary Logan

The discussions in the US this week surrounding the constitutionality of health insurance payment mandates and the fact that my terminal degree is in health policy helped me to choose a topic for this week’s post. The US Supreme Court question that the Justices are examining this week has to do with the issue of insurance payment mandates for individuals—is it constitutional? The goal of Obama’s The Affordable Care Act is a goal of healthcare for all within the existing system. One primary argument of those supporting the plan is that, while not perfect, the plan is a good start in transitioning to a universal healthcare system. Yet the plan and the current discussions make a number of unstated assumptions about a healthcare system embedded within a capitalist, free market economic system of the wealthiest country on the planet. These assumptions need to be exposed in order to view the problem systemically. I would suggest that these assumptions are not even correct to begin with for the existing system, and that the assumptions will become even less true in a permanently declining economy associated with peak oil. Rousseau said, “Good laws lead to the making of better ones; bad laws bring about worse.” In my opinion, creating bad laws now that assume that the current system can grow infinitely only lead to further catastrophe. Continue reading Healthcare for All in the U.S?