CAUGHT DIRTY HANDED

“Wash your hands!” cry flu epidemiologists, mothers, nurses, and Tim Barrus.  That last because he cares for boys with HIV, meaning they have no immunity to germs and no ability to develop immunity.  When I took a job at a nearby county nursing home as ward clerk, I thought that since I sat in an office at a computer, hand-washing was not so crucial.  I bristled and balked at the infection control nurse whom I thought was a bully and took her position as an excuse to target and persecute people.  

My neighbor thought I was funny when I described my feelings about this nurse.  When she took a job as a nurse’s aide in the same place, she had the same class in hand-washing and she liked it, thought it was very worthwhile.  One looks at statistics and microscope photos of germs.  One puts red indicator stuff on the hands and then tries to wash it off to illustrate that it takes a lot of careful scrubbing with systematic effort and time.  One is supposed to scrub hands for as long as it takes to sing “Happy Birthday.”   Then one day my neighbor discovered that an unknown aide had stored a wheelchair with feces caked onto it.  She quit.

The best protection is human effort.  Only motivation can protect us.  But there is a webwork of forces in play.  One of the most unexpected and difficult to address has been antibiotics, the miracle med that changed everything for childbirth and war trauma.  They were such an effective force that it was thought justifiable to be more casual about surgery sterility or ordinary patient care.  But antibiotics became a blunt-force weapon, used even for viruses, which antibiotics do not affect.  They are useful only for bacterial germs.  And the fact that when given to livestock as a preventative, they released energy in the animal that let them grow larger faster, meant that they crept into meat.  A third force was that people took their pills casually, not completing the full span of what the doctor prescribed and giving their leftovers to friends or children with the thought of doing a healing kindness.  On the rez they became a political element with patients who were refused antibiotics by doctors who said they were wrong for the diagnosis becoming irate and demanding them, thinking that they were being denied a magic element out of racism.  All these things left germs opportunities to mutate resistance.  

Leland Ground was in my original English class of seventh graders when I was first hired in Browning, Montana, in 1961.  His family is distinguished (some will recognize the name of Mary Ground as a ceremonialist and matriarch) and that particular class was also identified as high achievers.  (In those days we weren’t afraid to say so.)  Decades ago Leland was in an auto accident that badly broke his leg.  Surgery mended the bone with rods and screws.  Over the years the screws worked loose, so about five years ago Leland went back for more surgery.  A veteran, he used the VA hospital.  

His leg became infected with a MRSA -- methicillin-resistant Staphylococcus aureus.  The next four years were hand-to-hand combat on the part of both Leland and his dedicated doctor to save his leg from amputation.  Antibiotics, even the ones that are reserved for worst cases, failed.  Installing ports through his skin for dripping antibiotics directly into Leland’s system, which he did daily himself at home, failed.  Except that it caused nausea and memory lapses, general fogging of thought.  Re-opening the incision to clean it out failed.   Radioactive tagging of the infection so as to follow it into the bone failed.  The doctor did not give up.  He finally won.  The whole VA system has been struggling with this and now the media are beginning to report success.

Another person in that class of seventh graders was Mike McKay -- from another distinguished and achieving Blackfeet family.  For some years a while ago he was in charge of cleaning and maintenance of the Browning Indian Health Service hospital.  Once he said something offhand to me about it not being a very high status job (one brother is a lawyer and  a sister is the superintendent of the Browning Public Schools).  I jumped all over him!  He had one of the highest responsibilities on the rez!  He was a crucial partner of the doctors!  Since then he has gone back to college for graduate degrees in science.

Among the things the VA tried -- besides hand-washing -- was changing protective gowns between rooms, wearing masks, and more completely sterilizing rooms.  No matter what they tried, it was effective EXCEPT that people wouldn’t do it.  They were in a hurry, they didn’t really believe it mattered, they forgot.  It was expensive.  The experts could get maybe eighty per cent compliance, tops.

Another strategy was to test patients as they came in to see whether they were carrying MRSA germs, so as to isolate them for treatment.  This is controversial and opinions differ about how effective it is, but everyone was surprised to see the results of the tests -- so many germs!  So wicked!  The best result was that when people could see the extent of the problem, they bought into the solution and tried harder.

But there is another entirely different school of thought out there.  Immunity results from an interaction with the environment.  Medical interventions like vaccination are only an imitation of responses normally triggered by mild infections.  They are good because some of the infections are NOT so mild, in fact, deadly.  (There is backlash even against  vaccination from people who fear interventions with nature.)  Apart from the major diseases that sweep around the planet, killing people in pandemics that keep populations within previously unexceeded limits, there is constant daily interaction between creature and ecology that “teaches” the body how to live there.  Scientists who are thinking along these lines think we don’t get enough dirt in our systems to connect our bodies to the web around us.

Small wonder.  Chemical companies are making fortunes by promoting fear of germs and contamination and then selling us potent “sterilizing” molecules that go to work on the cells of our own bodies, interfering with the systems that control our functioning.  Now we’re beginning to fear those substances and move to “steam cleaning.”  It seems like a better alternative though it means yetanother expensive appliance.

That bossy nurse with her bar of soap was right.  Wash your hands.  But no need to get phobic about it.  No need to boil the patient to cure disease.  Though Leland, who has a strong sense of the ridiculous, laughed when I suggested he unscrew his leg, boil it, and then reinstall it.