Do you do not attach much significance to the question now asked while visiting your doctor or the hospital? It now becomes one of the questions that has assumed national prominence but also draws attention as to why another question isn’t being asked.
If you are returning from a trip abroad you are asked: Have you visited a farm or come in contact with farm animals while outside the country? Its purpose is to prevent the infestation of harmful pests and disease. If you are applying for credit, you are asked: How long have you lived at your current address? Americans on average move once every five years and the time at an address allows for a meaningful background check. If you are applying for a job, you are asked: Have you ever been convicted of a felony? This information, where permissible, might serve to establish issues of moral character. And if you are visiting a new doctor, you are asked: What drugs are you allergic to? This is helpful in guiding what to prescribe and to avoid complicating any treatment decisions.
Questions are key to establishing understanding and promoting communication with others. Questions also shape discovery and exploration. Many encounters with the justice system prompts the question: Do you see the defendant in the room? An attempt to determine the accuracy of testimony. Is it credible? The interview of a national figure by a reputable journalist often leaves you wondering why isn’t the question that’s on your mind not being asked. Or conversely, why is the question that has just been asked being asked.
Why are we now being asked: In the last 21 days, have you been out of the country? It certainly is not to extract a response that might indicate you have done something wrong. We are a free people. Its purpose is to identify whether steps should be taken to further examine and determine if you are carrying the Ebola virus if your visit had been to any country where the virus is prevalent. It is also to establish whether you might be carrying the Chikungunya virus. Both of these viruses are ravishing different parts of the world and the extent to which we can take protective measures to guard against an infection by either, the goal of the question would have been met.
Unlike the Chikungunya virus, which thrives in areas of environmentally unhealthy settings such as standing water and incorrectly disposed garbage and refuse because it is a water borne disease carried by the mosquito, the Ebola virus (EVD) is spread or challenges containment because of cultural practices. The regions where this virus has been identified and is prevalent, will for a very long time be associated with this disease, and the cultural practices that are never modified or totally abandoned will perpetuate fear of the disease’s continued presence.
What did the medical community do to improve the containment of the disease? They carried out a process of educating the Liberians that the washing of deceased family members’ bodies was a practice that allows the disease to thrive. This practice must be abandoned. A deadly cultural practice must yield to medical science if the lives of Liberians and those in the region are to be spared death and suffering. The washing of the dead now takes its place alongside of Female Genital Cutting (FGC) as a geographically connected practice that is entirely cultural and deadly.
But FGC has been known to the medical community for decades and is a practice that is present not only in Africa, Asia, and the Middle East; it is practiced even in this country. Sara Rashad’s film, Tahara, reminds us that this is a cultural practice that is inhumane, cruel, and the basis of many serious and protracted health problems for its estimated 300 million potential victims.
What would be a reasonable US medical community’s response to these practices considering the number of citizens from these countries who migrate or visit the US where either or both Ebola and FGC are prevalent? You would think that one place to start would be to include at the point of intake of a patient’s medical history this question: Where were you born? Regrettably, you won’t find this on any patient medical history form; probably anywhere in the United States. So much for population health.
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