These are the words of a friend of mine. My response was two choice words.
I work in public health. Disaster preparedness is something of a hot topic in my field. These days, we public health workers are now more like reserves. We are called up to respond when disaster strikes; for example, many of my co-workers were on the front lines serving the public after Hurricane Ike struck.
Swine flu's appearance caused operations activation, and it has become my turn. Our state is one of the early epicenters of the outbreak in the U.S., and I just spent much of the two days answering calls from anyone and everyone who came looking for information, treatment, supplies, reassurance, and just about anything else. This left me with some strong impressions.
First, there are a lot of sick people out there. And a lot of them are scared. Many, many people called us and said, "Help. I think I'm (or my child or my husband or my relative or friend is) sick. We don't have anywhere to go. We don't have a doctor, and we don't have money. We don't have insurance, and we can't afford the emergency room. It would break us. What do we do now?" Down along the border with Mexico, many people were accustomed to simply crossing to the other side for medical care, where it was easily and cheaply available in comparison to the system here. "What do I do now?," sobbed one mother I spoke to. Her children were sick, and she was afraid to take them to Mexico because she didn't know if they'd be permitted to cross while sick, and she doesn't have insurance to help her afford care for the kids here. She didn't even have a clue where to find services.
Where could we refer these hundreds of sick people? Those who had a doctor, we told to speak to their medical practitioner or clinic. Some already had -- and their doctor's office had simply said,"We don't deal with that. Here, call this 800 number." No referral to anyone else who could provide services. No advice. "It's not our problem," is basically how that read. In many cases, we referred people to their local or regional health authority to help them find other available resources, since we didn't have that information at the level where I was. Some of those local and regional health entities called us, furious that we were sending people to them in their communities looking for health resources. "We don't have that kind of information" or "we don't do that," they would say. Somehow it escaped them that perhaps they should have some idea what's available for people around them.
At least from my unprivileged vantage point, it seems like we weren't prepared for this. I should expect, by now, that not all private practices see any public health perspective...I see it all the time. Heck, not even all local health departments are fully plugged in to that perspective. It's sometimes hard enough just to get people evaluation and treatment for minor outbreaks of long-known treatable diseases. But when a major outbreak like this surfaces, and private medical practices, hospitals, laboratories, and public health departments don't know who each other is, don't know where to call for resources, and in some cases can't be bothered to respond reasonably quickly to assist the community, we run a tremendous risk of failure.
I chalk a lot of this up to the old Republican-style strategy of strangulation of public services through underfunding and mismanagement. Remember, government is the problem, not the solution -- and the strategy has been to make sure public services aren't capable of this level of response, so that when a disaster happens, the public perceives the public servie response as ineffective at best, if not outright disastrous (Hurricane Katrina being a tragic example).
Public health is one of those services which most people expect without any awareness that it supports the lifestyle to which they're accustomed. Many nations still suffer from serious major preventable health problems -- water and food-borne disease, tuberculosis, rabies, widespread sexually transmitted disease, poor infant nutrition, widespread incidence of diseases that vaccinations can prevent -- which disrupt their economies on a broad, daily scale. These health problems cost nations billions in lost productivity as well as millions of lives. Here in the United States, public health prevents or controls most of these health problems on a shoestring. The services are typically completely un-notable to the average person because they function shockingly effectively for the pittance of taxpayer money on which they subsist. People like my libertarian friend whose quote is the title of this diary have no clue that I and hundreds of people like me across the state are working feverishly (no pun intended) to make sure that he can continue to relax and proclaim this flu outbreak to be a joke. We're working our a$$es off to make sure it doesn't come knocking at his door; that it doesn't cause so many people to miss workdays that it tanks the economy that supports his very comfortable lifestyle. Even though he knows about my work, he still doesn't connect it to the comfort in which he lives, or have a clue how many people work very hard for pitiful salaries because they're committed to protecting the public health.
And public health isn't the only public service for which I could write such a description.
That said, critical underfunding and mismanagement have left us in a precarious situation. How do we respond to outbreaks like this when we can't effectively treat the hundreds of thousands of people in any given state who just don't have the resources to afford the expensive, cumbersome healthcare system of the present? What happens? I fear my friend would simply say, "Let 'em die." I'm afraid to ask.
But there were quite a number of calls that came in that were about "those people". You know who I'm talking about. There always has to be a "them". One caller said to me, "My parents live around a lot of those people...you know. The ones without documents. What should we do?" Another woman called in furious that someone who looked like she might be an undocumented migrant was sitting in the ER, ill, and sharing airspace with her and her daughter! My co-worker who took that call was so floored that she could just barely manage to ask, "Ma'am, is she not human? Does she not deserve medical care?" I have no idea what the caller's response was, but lots of callers want us to keep those people from coming across our borders and giving us that disease. I could just spit.
On the whole, though, when I was leaving to return to my own much quieter office, it seemed like things were beginning to come together. Some local and regional health departments had opened up response centers of their own, and called us to coordinate services. Many of the people who called for information got what they called for -- and left our lines seeming comforted and perhaps more informed. Word came that the laboratories had finally come through with information on where samples were to go for testing, and that testing, and the supplies to do it, were FREE OF CHARGE. I started to think we could pull it off -- or at least begin blunting the outbreak. There is still so much misinformation, so much prejudice, so much fear, so much isolation between layers of services. I hope that this outbreak is mild enough to serve as an impetus to learn lessons and be more prepared next time. If this disease were more virulent and fatal than it already is, what I saw from my lowly level left me in fear that we would be woefully unprepared to save lives and stop it.
There are many people doing lots of good work, but this can't be as good as it gets. We must do better.