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Leeches for sale: The economy of bloodletting in France, 1827-1836

N8000057-Leech_use,_historical_artwork-SPLI found this great post on drug shortages that appeared in BMJ today.  Among all of the other great gems in it, was this incredibly interesting article on the creation of a mechanical bloodletting device. Jean-Baptiste Sarlandière, a French anatomist and inventor, created the “mechanical leech”, a device intended to extract a controlled amount of blood from the body. Sarlandiere intended the device to replace leeches, which were subject to increasing demand, were becoming expensive, were difficult to cultivate, and were subject to shortages in the Netherlands, who was a large producer of leeches at the time.

A paper was written on the device back in 2009, and within there is a dataset of leech imports and exports to France, which includes data on the monetary value of leeches and public consumption. Of course, I couldn’t resist pulling this data out and doing something with it (despite having better things to do.)

Here is the data, pulled from yet another paper (Alexandre E Baudrimont, Adolphe J Blanqui, et al.Dictionnaire de l’industrie manufacturie`re, commerciale et agricole, Paris, J-B Baillière, 1833–1841, pp. 25–30.):

Year Number of leeches imported Value in Francs National consumption Exports Import export ratio Value per leech
1827 33653694 1009611 33456744 196950 170.87 0.03
1828 26981900 809457 26689100 292800 92.15 0.03
1829 44573754 1337212 44069848 503906 88.46 0.03
1830 35485000 1064550 34745848 739250 48 0.03
1831 36487975 1094639 35245875 1242100 29.38 0.03
1832 57487000 1724610 55591700 1895300 30.33 0.03
1833 41654300 1249629 40785650 868650 47.95 0.03
1834 21885965 656579 21006865 879100 24.90 0.03
1835 22560440 676813 21323910 1236530 18.24 0.03
1836 19736800 592104 18721555 1015245 19.44 0.03

Leeches

Of course, I am fascinated with this. The number of leeches exported from France rose during this period as did the market price of each leech. Though the entire industry would eventually collapse because other medical advances of the nineteenth century would supercede it, it is clear that increased demand and expense led to innovation to create devices to replace it. I don’t know whether the “mechanical leech” led to the development of other medical devices, but would like to think that even batshit ideas like how swamp worms draw out blood to cure any and all medical conditions would lead to the creation of methods which do improve health.

Detroit Communities Reducing Energy and Water (use): Jefferson-Chalmers edition

test (9 of 11)Once again, I tagged along on a trip to Detroit with the D-CREW, a community based participatory research project aimed at developing strategies to improve housing and thereby reduce wasteful water and energy use in Detroit communities.

This weeks data collection efforts focused on the Jefferson-Chalmers area of Detroit, just adjacent to Gross Pointe.

Data collection went as smoothly as before, but with a more affluent and sophisticated group of people the vast majority of whom own their own homes.

The informational session became quickly energized, with participants asking pointed questions like “how is this research going to benefit us?” “are you going to sell our data?” “is my cousin going to be able to see my data?”

Doing research in the communities of Detroit is every bit as exciting and engaging as doing work in Kenya, where researchers are rightly met with skepticism, the goals of the research are obscure, and the direct benefits likely non-existent.

Pollen allergies and asthma study begins!

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Get your immunotherapy shots here

Currently, I am a part of a project looking at climate change impacts on the distribution of tree and grass pollens in the US and associations with allergy and asthma related emergency room visits

As part of that, we are collecting baseline data on symptomatic profiles of patients who are sensitive to tree and grass pollens and are currently undergoing immunotherapy in local clinics.

Our survey is two fold, the first a baseline survey of types of demographics, types of allergies, seasonal sensitivities, general symptoms and lifestyle impacts, the second a three week survey of sleep quality and allergy and asthma related events.

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University of Michigan School of Public Health Masters student Erica Bennion explains the goals of the study to a potential participant.

We hope to gather data to see how the ragweed season might impact general health and well being using a coarse raster of predicted pollen distribution.

The survey is being conducted at the University of Michigan Allergy Specialty Clinic and Food Allergy Clinic at Domino’s Farms and will include approximately 50 people.

New chapter from myself in a Springer volume: “Access to Health Care in Sub-Saharan Africa: Challenges in a Changing Health Landscape in a Context of Development”

SpringerBook_I wrote a chapter for “Health in Ecological Perspectives in the Anthropocene” edited by Watanabe Toru and Watanabe Chiho. I have no idea if they are related. Either way, my chapter “Access to Health Care in Sub-Saharan Africa: Challenges in a Changing Health Landscape in a Context of Development” occupies pages 95-106 in the volume.

Check it out, you can buy the book through Amazon for a cool $109, or just my chapter through the Springer site for $29 or you can simply write me and I’ll give you a synopsis.

Success!

Here’s the abstract for the book:

This book focuses on the emerging health issues due to climate change, particularly emphasizing the situation in developing countries. Thanks to recent development in the areas of remote sensing, GIS technology, and downscale modeling of climate, it has now become possible to depict and predict the relationship between environmental factors and health-related event data with a meaningful spatial and temporal scale. The chapters address new aspects of environment-health relationship relevant to this smaller scale analyses, including how considering people’s mobility changes the exposure profile to certain environmental factors, how considering behavioral characteristics is important in predicting diarrhea risks after urban flood, and how small-scale land use patterns will affect the risk of infection by certain parasites, and subtle topography of the land profile. Through the combination of reviews and case studies, the reader would be able to learn how the issues of health and climate/social changes can be addressed using available technology and datasets.

The post-2015 UN agenda has just put forward, and tremendous efforts have been started to develop and establish appropriate indicators to achieve the SDG goals. This book will also serve as a useful guide for creating such an indicator associated with health and planning, in line with the Ecohealth concept, the major tone of this book.  With the increasing and pressing needs for adaptation to climate change, as well as societal change, this would be a very timely publication in this trans-disciplinary field.

My Children are Seven in Number

WYTfXNot sure why but for some reason over lunch I got interested in old labor songs. This one was particularly bleak. Apparently, it is intended to be sung over “My Bonnie Lies Over The Ocean.” As our administration erodes labor and environmental protections for the inexplicable sake of bringing back coal mining, it pays to have a look back at how bad it really was.

Song: My Children are Seven in Number
Lyrics: Eleanor Kellogg(1)

Music: to the tune of “My Bonnie Lies Over the Ocean”
Year: c.1933
Genre:
Country: USA

 

My children are seven in number,
We have to sleep four in a bed;
I’m striking with my fellow workers.
To get them more clothes and more bread.

CHORUS:
Shoes, shoes, we’re striking for pairs of shoes,
Shoes, shoes, we’re striking for pairs of shoes.

Pellagra(3) is cramping my stomach,
My wife is sick with TB(4);
My babies are starving for sweet milk,
Oh, there as so much sickness for me.

Milk, milk, we’re striking for gallons of milk,
Milk, milk, we’re striking for gallons of milk.

I’m needing a shave and a haircut,
But barbers I cannot afford;
My wife cannot wash without soapsuds,
And she had to borrow a board.
This song was originally posted on protestsonglyrics.net
Soap, soap, we’re striking for bars of soap,
Soap, soap, we’re striking for bars of soap.

My house is a shack on the hillside,
Its doors are unpainted and bare;
I haven’t a screen to my windows,
And carbide cans do for a chair.

Homes, homes, we’re striking for better homes,
Homes, homes, we’re striking for better homes.

They shot Barney Graham(5) our leader,
His spirit abides with us still;
The spirit of strength for justice,
No bullets have power to kill.
This song was originally posted on protestsonglyrics.net
Barney, Barney, we’re thinking of you today,
Barney, Barney, we’re thinking of you today.

Oh, miners, go on with the union,
Oh, miners, go on with the fight;
For we’re in the struggle for justice,
And we’re in the struggle for right.

Justice, justice, we’re striking for justice for all,
Justice, justice, we’re striking for justice for all.

Links I liked

 

Heat map based density plots in R (link)
101 awesome public health blogs (link), many of these are old and dead (like me!) so this one with only 75 blogs was a bit more useful (link)
Tech can’t solve all problems, but it can help with some. (link)
R, working with raster files in Shiny (link)
Why health care costs so much (link)

And some great shamisen action from Ichikawa Chikuyou.

A visit to the local witchdoctor: treating snakebites in Kwale, Kenya

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Wound from a puff adder bite

Humans have had to deal with the threat of snakebites as long as humans have existed. While deaths from snakebites are rare, the outcomes are so severe and the nature of the animal so mysterious, that humans have developed all sorts of ways of dealing with them.

Witchdoctors, or Mganga as they are known in East Africa, are the first line for snakebite treatment here. The Waganga are fairly useless for treating many serious health issues, but they have carved out a niche for themselves for a few public health problems.

Our survey in Western Kenya confirms that nearly 100% of people who have been bitten by a snake visit the Mganga, regardless of whether they visit a formal health facility or not.

I went and sat down with an established Mganga here in Kwale and he was gracious enough to answer all of my questions openly and (mostly) honestly.

Hello, thank you for taking the time to speak with me today. Is English OK?

No, my English is not very good. Can we do this through a translator?

Of course. So, what happens when a patient comes in for treatment for a snakebite?

When the patient comes in, I first apply the “njiwe na njoka” (lit: snake stone). The stone sucks all the poison out of the wound. When you put it on the bite, it will stick. When the stone has absorbed all the poison, it will fall off.

What do you mean? Like it just sticks to the flesh without tying it?

Yes, if there is poison, the stone will stick to the body. When all the poison is gone, the stone will fall off. After it is done, I take the stone and wash it with milk several times and then use it again for the next patient.

What is the snake stone? Is it like a rock? I’ve seen people use charcoal in the villages. They tie it to the wound, it doesn’t appear to stick on its own.

No, this is different. This is a stone from the snake. The stone is in the skull of the snake, like that of a fish.

(Note: I did not know this, but some species of snakes have otoliths, like most fish. Snakes (and fish) are deaf in the traditional sense. The otolith is a piece of calcium which grows as the animal ages and sit on top of a bed of nerves. When there are vibrations, the otolith vibrates, stimulating the nerve bed so that the animal can “hear” motion around it. Not all snakes have otoliths but some species of burrowing snakes do.)

Where do you get the stone? Can you just buy it in the market?

The snake stones come from the Maasai, from big snakes in Maasai land. My teacher travels to Maasai land to get them and brings them back.

If the wound is fresh, I apply the stone. However, if it has been two or three days since the bite, I can’t use the stone anymore. Then I have to use a special medicine made from herbs and crushed snake heads. I mix it all together, then crush it into a powder and keep in a gourd.

When the patient comes in, I use a new razor blade to make small scratches on the wound. Then I rub the powder in it and bandage the wound. The wound will try to heal over time, so you have to make the scratches to be able to apply the powder.

Do you use the razor blade again?

No, I always use a new blade. (He was emphatic on this point.)

What is the powder made from?

Snakeheads. When we kill a snake, we keep the heads to make the powder. We mix it with roots, bark and leaves from special plants from deep in the forest. My teacher is a security guard in one of the forests and can get them when he can find them.

Wait, so your teacher is a forest ranger? Can’t he get by being an Mganga?

Yes. He is a forest ranger.

So he took the job so that he can get the plants from the forest whenever he needs them.

 (Silence)

OK, so how many bites do you see per month?

It depends, some months I get more than others but mostly one every three months or so.

Do you refer them to the health facility for formal treatment?

Yes, I do. I treat them, then they go to the facility, then they come back to me. (I’m suspicious on this point, though the Mganga in question appears more together than most.)

Is there a religious component to this?

Well, there are two kinds of bites, those where the snake just bites and there is no witchcraft and those where someone has used magic to send the snake to bite you.

How do you know the difference?

If the bite heals quickly, there is no witchcraft. But if the bite is treated and does not improve then there is definitely witchcraft involved. At that time, I have to use powerful magic to get rid of the curse.

What do you do?

I send the snake back to the person who applied the curse. When we hear that someone nearby has been bitten, we know who applied the curse.

(Note: this is not uncommon. Witchcraft is often associated with hatred and revenge but the person applying the curse risks becoming cursed themselves. It is possible that snakebites are seen as a never ending battle of malevolent spiritual forces. What this does is sow distrust among people, even families and the Mganga is seen as the only cure. The result is that the Mganga are never without work.)

How did you learn this craft?

I was sick for a long time with stomach and head problems. I went to the hospital and it never got better so then I went to an Mganga. I improved. The Mganga suggested that I become on and I started training under him.

Thank you very much for your time.

 

 

Snake Bites in Kwale, Kenya: Into the Field

snakebitesWe just spent the day driving around Kwale looking for snakes, and/or people who had been bitten by snakes. As the last post showed, snakebites are a persistent problem along the Kenyan Coast, with more then 5% of the households we survey indicating that at least one person in the household had been bitten in the past two years.

It wasn’t difficult to find them.

Snakes are universally feared all over Africa and the associations with witchcraft make it a common topic of discussion. Everyone knows someone who has been bitten. They often know all the details, including where it happened and what occurred following the bite. It’s never a happy story.

We went deep into Kinango, an extremely rural area west of Kwale Town and found a friendly lady who seemed to know everything about everyone. She was incredibly jolly, pulled out some plastic chairs for us to sit under and cracked jokes the whole time. I even got to copy her collection of Sangeya music which she had recorded on her phone (another post but you can hear some of it here) at some local music festivals. In total I got more than five hours of live Sengeya and Chilewa music. In the music world, these would be called “field recordings.” Here, this is just music she cooks and cleans to.

Switching back and forth between snakes and Sengenya (in Africa it seems to be possible to have multiple conversations at once), she told us about a kid who had been bitten two days previous. She even told us where to find her, so off we went.

The child was collecting firewood around a mango tree near her home, when she was suddenly bitten by a large green snake, not once but three times on the foot. The snake bit once skated away, decided it wasn’t enough and came back and bit her twice more.

Ants had moved into the dead tree and hollowed out the area underneath. Presumably, the snake moved in previously and came out to warm up during the day.

The mother thankfully took the child immediately to Kinango Hospital and treated was administered. The child was given a three day course of antivenom injections and charcoal was wrapped around the wounds to absorb any venomous discharge. Though the child complains of some numbness in the area, it looks as if there won’t be any permanent damage. Thankfully.

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Snake bite (species unknown). Note the charcoal. Victim is a 10 year old girl.

We were also told of an old woman who had been bitten more than 20 years ago, and was badly scarred, figured out where she was and off we went again.

As we pulled up a friendly young lady came out to greet us, and showed us the way to the house out back. In the distance, we could see an old lady walking with a limp. Otherwise, she was completely fit and seemed to be cutting her own firewood with a panga.

She brought us out some chairs and sat down to chat. In 1992, she had been out back collecting firewood (a pattern) and was bitten on the foot by puff adder, one of the deadliest snakes in the world. She was bitten on the foot, and became immobile for nearly a week. A series of witch doctors were brought in, who administered charcoal rubbed into small cuts in the skin.

Necrosis set in, and watery blood erupted out of the wound site. A large number of maggots appeared. Finally, someone had the good sense to take her to the hospital, where she spent an entire year.

The details were unclear, but it appeared that the gangrene was so severe that multiple infections were presents. They likely had her on intravenous antibiotics for an extended amount of time. Despite this, the foot did not heal. Some Christian missionaries came, and convinced her to convert to Christianity, which, she claimed, improved her condition. This is likely coincidental.

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Puff Adder wound. Note the permanent curvature of the foot. She continues to have to wrap it and use topical medication, 24 years following the bite.

The doctors suggested a skin graft to improve the foot, but she refused. Necrosis was so deep that it permeated the bone and the foot is permanently curved as a result. The leg still shows sign of swelling even more than 24 years after the bite. In most cases, they probably would have simply amputated.

The lady was born in 1948, bore ten children, one of which was born just as she was bitten. She was unable to breast feed or care for the child. Regardless, the daughter has two children of her own now.

Snakebites are bad news. In this woman’s case, the disregard for proper medical care simply made a bad situation worse. She is truly lucky to be alive. If she had died, it is doubtful that the Mgangas would have admitted any responsibility.

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Puff Adder victim, born in 1948. Ten kids. Still going strong.

At the KEMRI Scientific and Health Conference: what is the way forward for African research?

I didn’t hear about this until the very last minute, but was lucky enough to get the invitation letter in time to at least make it to the last day.

The Kenya Medical Research Institute (KEMRI) has, for the past five years, held a research dissemination event intended to highlight KEMRI sponsored and Kenya based research.

Research led by Africans is sadly scarce. R&D funding in SSA is the lowest in the world. In a context where so few people are able to receive an education of sufficient quality to allow post graduate studies, African researchers are few and the resources available to them are low.

Kenya has committed 2% of GDP to R%D. Contrast this with South Korea, which at one point committed 23% of GDP to R&D efforts. While KEMRI is truly a leader in the context of African research, the low level of commitment on the part of the national government makes it tiny in the context of worldwide research.

The presentations I have seen so far have been excellent, but of course, much of this research survives on the good graces of international funding and training. Most of the research presented was performed within the CDC.

So this begs the question, when will and can African countries take ownership of their research? Is this even possible given the dysfunctional nature of politics here?

The story of Africa and African identity (in a global context) is written by the rest of the world. As a foreign researcher, I quite aware that I am part of this phenomenon.

Presenters have pointed to two main issues (which I agree with). First, African countries cannot proceed to develop their research sectors (or any other sector really) unless Africans take charge of in country and continent wide research priorities. It is important to note that foreign research often takes on issues which were of importance in the colonial period (childhood infectious diseases) despite a growing burden of chronic diseases and diseases of aging which will break the budgets and economies of African countries.

While I do not suggest that attention be diverted from the incredible burden of infectious disease in African countries, it is telling that research priorities are still driven by the international community. Central Province in Kenya is quite well developed. Even my taxi drivers ask me why we don’t do research in Central, given the incredible problems of heart disease, cancer and alcoholism up there. Unless Kenyans spearhead the main issues impacting their country, these problems will go unadressed.

Second, as noted before, governments have to make firm commitments to support domestic research. As of now, African countries wait for international funding to support their projects, which shifts the conversation away from domestic priorities to international priorities. This is a tall order here, of course.

Of interest, though, besides the macro level problems of funding and support, presenters passionately call for people with Masters and PhD to use the degrees. “Why don’t you do research? What is wrong with you?”

I can’t speak to this issue effectively. But my sense is that many capable people don’t sense the urgency of doing research and lack the personal initiative to make it happen. I’ve seen it happen that researchers wait to have foreigners write their research for them, and simply wait to have their name rubber stamped on the paper, taking credit for work that they did not do. This is an unacceptable situation that we, unfortunately, enable. Certainly there are issues of experience and capability, but we shouldn’t handle capable African researchers with kid gloves, particularly this well educated young generation.

Sadly, the history of aid and foreign involvement here has set this precedent. This is an era that needs to come to an end. In the private sector, it has. In the public sector, these problems persist. Older researchers, many of whom came of age during the beginnings of the post-independence era, here are screaming that point at the top of their lungs.

Links I liked January 23, 2015

Measles cases by yearSome public/global health things that caught my eye today:

1. A visit to the most sickest town in America, a coal mining town in Virginia. Dear Republicans, pay for health care now and abandon “clean coal” or pay more later. It’s up to you. (The Atlantic)

2. How paid sick leave could boost American productivity. (CEPR)

3. Dealing with antibiotic resistance is going to take more than just technology. We can’t sit by and watch everything burn around us while we wait for new drugs to come down the pipe…. because they aren’t coming. (Project Syndicate)

4. I want to deny vaccine deniers. Generally speaking, I don’t like people who are willing to sacrifice kids for politics. Vaccine deniers stick together and increase risks for everyone. (WP) and this one, which puts it all into a nice picture for you. (WP)

5. Diseases without borders: ignoring the problem of piss poor health care in developing countries won’t help us from Jim Kim of the World Bank. (Project Syndicate)

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