Sunday, July 19, 2009

Aboriginal nurses concerned about impact of H1N1

A.N.A.C. [the Aboriginal Nurses Association of Canada] is particularly concerned with the impact of treating cases of H1N1 will have on small and remote First Nation communities. Many Aboriginal people in these communities live in overcrowded conditions and over 100 First Nations still do not have running water. The issue is also related to nursing support needed for severe cases of H1N1 which can lead to extended hospital stays and lengthy home support in the community after hospital discharge. There is a shortage of nursing support staff in rural and remote areas.

Read the whole article on Wataway News Online.

Thursday, July 16, 2009

Worth Reading

Two posts i strongly recommend you all read:

Please, check them out.

Wednesday, July 15, 2009

H1N1 and Us

My personal relationship with H1N1 – the swine flu virus – probably lasted about a week, but i was only physically aware of it for maybe 48 hours, tops. Getting H1N1 – and if you have the flu this time of year, chances are you have it – has been described as similar to being run over by a bus, which an hour or two later puts itself in reverse and backs up over you again. But for me it was more reminiscent of a teenage drug trip, and as i lay in bed veering between the chills and fever, i thought that this wasn’t as bad as all that.

That was May 15th, and by the evening of the 16th i was “better” – though probably still contagious. Where did i get it? Chances are from my husband, who we now know must have caught it earlier that week. And where did my husband catch it? Who knows – could have been the corner store, the movie theatre we went to that week, or the restaurant we ate at. Lots of possibilities.

Now while H1N1 hit me quick and hard and then moved on, it doesn’t always play that way. When I first started on this blogpost, I had been living for seven weeks at the intensive care unit of one of the best hospitals in town. While our daughter and myself recovered quickly enough, H1N1 almost killed my husband. Although he is recovering much faster than initially expected, even now at home (since last Friday!) he is still incredibly weak, and will require help managing regular daily activities in the weeks and months to come.

Having him at the hospital for so long - and me being there for the same period of time, sleeping on the couches, trying to maximize my time around him, for we had been told he might die - i have lost all perspective. When a thing like this happens it ends the narrative of ones life as it existed, but by the same token one does not stop seeing things as one has for decades. So i lost perspective, but my lost perspective found its form in the concepts i still understand my world with.

I cannot say if i first began to write this to distract myself, or because i had something to say. This personal crisis seems to echo political questions I have thought about over the years – or does it? Could it merely be that a personal crisis like this colors everything, bleeds its meaning and its terms into old thoughts and preoccupations, resuscitates discarded ideas like zombies in a Romero movie?

A year ago some beautiful comrades, people who have inspired me in so many ways, sent me a draft paper about the flooding of New Orleans – they raised the hard question, not of why the State had been absent in planning humanitarian relief prior to the disaster, but why the oppressed had not been prepared, had not been politically forcing the State to fix the levees, had not been preparing for the flood before Katrina came:

In real life, women had time to organize a response to the looming destruction of New Orleans. Time to organize neighbors and families to construct communal flood defenses, to go on the offensive and stop profitable port cargoes from being unloaded or luxury tourist hotels from operating. To concentrate everyone on defending the Black Metropolis. Time to unofficially, illegally take over disaster planning from the patriarchal capitalist state. No, there weren't days but years of warning to do all these things. Not months of warning but decades of advance notice.

This is hard, but is in many ways true. But as i first read it i wondered – and still wonder – if it doesn’t harden itself a bit too much by leaving out other truths. Namely that we can’t see which disaster is coming down the tubes, even though we all know that one is surely on its way. After all, we “knew” that New Orleans would be flooded, just as we “know” that global warming will sink other cities (and nations), we “know” about peak oil, we “know” about peak water, we “know” about the oceans turning acidic, we “know” about the San Andreas faultline, and we “know” that a flu pandemic will eventually come and kill untold numbers… but in our bones how much of this do we really know? For just as most if not all of these calamities are in the cards, we don’t know what will hit us first, what will just miss us, what will be pre-empted by some other disaster… and what experience does tell us is that most of the time, it’s not an unusual disaster that will kill you, but life as usual. More likely to be killed by your spouse than a serial killer, more likely to be hit by a speeding car than a planet-killing asteroid. That’s just life.

i started writing this on an evening home from the hospital, where the “swine flu” everyone was so scared of did indeed almost kill someone i hold dear. i write the above prior to writing what comes next. It’s a caveat, because i feel there is a harmful tendency to seize on the comic-book-super-spectacular calamities as a way of distracting ourselves from the everyday grind. And yet i do continue to write, because history contains both everyday violence and oppression, as well as spectacular stuff that would defy the imagination of any science fiction author.

What Autumn May Bring

Flu viruses normally go to the southern hemisphere this time of year, and return in the northern hemisphere’s fall season. That anticipated fall hit is expected to be more widespread than what has happened so far; deaths will definitely happen one way or another, just like they happen from the regular flu. (And from accidental falls. Not to mention traffic accidents.)

Compared to the regular flu, H1N1 seems slightly more deadly (0.25% as opposed to 0.1% fatality reported in the u.s. as of a few weeks ago, so one in four hundred instead on one in a thousand infected people) and because most of us have no pre-existing immunity it is expected to be slightly more prevalent (a quarter to a third of people in Canada are expected to get infected, as opposed to a fifth to a quarter with the normal flu). Slightly worst than regular flu season, but nothing cataclysmic. According to the WHO, while it is a pandemic (meaning it is present around the world) it is only an illness of moderate severity.

News reports seem to back up this relatively reassuring – and not necessarily inaccurate – picture. While thousands have officially been infected in Canada, for instance, less than fifty have died. This pattern is repeated around the world, or so it would seem, and stands in comforting contrast to the original reports of hundreds of dead in Mexico (since re-appraised to just over 100).

Yet there are holes in most of the media reports, holes which do not indicate conspiracy or impending doom, but which are worth noting. Holes which may explain some of the disconnect between the initial hype and the seemingly mild reality, a disconnect that can be triangulated with the tragedy that has played out amongst Indigenous people in Manitoba this summer. Holes from which i would suggest we may eventually draw elements of praxis, all the better to orient ourselves around and towards other sensational but potentially real disasters.

The main omission is easy to locate: the newspapers and government spokespeople have been quick to tell us how many are officially infected and how many have died, but for months they mentioned scarcely a detail about how those who died succumbed. Complementing this info-gap is the lack of any reporting on the numbers in ICUs or on ventilators (outside of Manitoba) - occasionally a report will indicate how many have been "hospitalized", but it remains unclear how many of these are in critical condition. And it is these facts that would actually be far more useful in terms of predicting the effect a possible spike in infections come the fall, and in identifying weak points in the medical infrastructure in time to correct them. A way of seeing which groups are most at risk of falling within those 25-33% who will probably become infected, in order to prevent this from happening.

You see, a certain number – and it’s currently impossible to know how many – of those non-deadly H1N1 cases are much like my husband’s: people in whom the virus does not follow its relatively benign trajectory, but in whom it provokes severe damage to the lungs and other organs. In my husband’s case, by the time we got to the ICU (after 72 hours in the ER) the flu had triggered septic shock – a failure of the circulatory system – and Acute Respiratory Distress Syndrome, an oftentimes deadly devastation of the lungs caused when toxins spill into them from the blood system. ARDS is thought to be the cause of most of the deaths in Mexico in March.

The media reports so far do not tell us how many people with H1N1 have suffered these serious complications. This is important as once the virus leads to something as serious as ARDS the only thing preventing one from dying is the ready availability of a ventilator combined with intensive medical care (as a recent Australian report explains, "Non-invasive ventilation is unlikely to improve the outcome").

At the ICU of the hospital where we were living, the ratio of nurses to patients is always better than 1:2, and some of the doctors specialize in lung care, specifically in dealing with ARDS. A fancy oscillating ventilator was available as soon as my husband got to the ICU, and while some of the staff seemed distressed at the levels of “disorganization” regarding isolation procedures, as an outsider looking in all i saw was an incredibly smooth running operation. In terms of people who contract this flu, my husband is very unlucky, as the illness turned so horribly nasty. But in terms of people who suffer such a vicious bout of the flu, he was extremely lucky, receiving an incredible level of medical care at one of the best hospitals in the province.

My concern is largely informed by my impression that this level of care will prove far above that which most people will receive, especially if the numbers of serious cases spike and the medical system begins to strain. The term used to describe the system’s limits in such a scenario is “surge capacity”, and nobody seems to be publicly discussing what the surge capacity of the health care system overall, and more importantly in particularly vulnerable areas, might be. (Googling, i see that over the past week there has in fact been some public discussion of this element of the equation.)

We know of course what shape such a spike in infections would most likely take – it would be invisible to most people, or else would seem silly, the exception that proves the rule. It will not occur amongst “the population at large”, and will seem to be caused by intractable underlying factors. It will occur in communities that “already have problems”, and anything that exacerbates the situation – as for instance the government’s murderous decision to block the distribution of hand sanitizer to Indigenous communities – will be referred back to said problems. In other words, H1N1 will follow the contours of power and privilege, poverty and oppression, as already established in the world as it is.

& a surge in specific isolated communities could be devastating. This is where this question emerges within our line of sight. Without an ICU to keep him alive, my husband would be dead right now. If numbers of critically ill people surge in particular communities, the probability of individuals being deprived of such full-on care will quickly become all too real. Without knowing how many people are currently on ventilators and receiving intensive medical care, it is impossible to rationally gauge what kind of resources may become necessary later this year. If these resources are not available, that could easily change the mortality rate of this disease. (Anticipating the fall's surge, the government is currently trying to purchase enough ventilators to bring its own stockpile up to 500 - how and when these will be made available will be of some importance.)

Even if stricken individuals can be evacuated to big cities where extra ICU beds and ventilators may be found, a host of related, lesser but still important questions arise. For instance, how will families and friends of these sick individuals be supported to be around their loved ones? One serious complication that can arise from ARDS is Post-Traumatic Stress Disorder, and studies have specifically emphasized the inclusion of family members in ICU care as being a factor that can lessen this stress. With people being transported hundreds of kilometers from their homes, how will this care be ensured?

As large numbers of people end up in ICUs, potentially for many weeks, the question also arises as to what follow-up will be made available? The ICU experience, while necessary to keep one alive, is itself a serious assault on a person. Muscles atrophy after weeks in bed or unconscious, other health complications can occur, not least of which are psychological problems resulting from the trauma. Some hospitals have begun offering post-ICU clinics to help former patients deal with such aftereffects, but these are still rare in Canada.

So this could be a serious problem in some communities.

H1N1 and Us
Dealing with potential disasters provides a challenge to the rev left, one which we still do not solve easily. A correct approach would entail preparing to meet the needs of people after a disaster strikes (serving the people) while not adding to the hyperbole, panic, and conspiracy theories which breed so easily in disaster-oriented political activism. Ideally it would entail building our capacities in ways that will endure even when a potential disaster does not come to pass (and remember: it is in the nature of potential disasters that most of them will not come to pass). A correct line should provide an opportunity for us to radicalize ourselves and others, by deepening our connection with the oppressed. As disasters often provoke fear, and fear often provokes reactionary ideas, a correct approach should also contain an anti-fascist dimension, combatting exclusionary ideas and practices not only in society at large, but specifically within more vulnerable communities.

Those of us who do not live within frontline communities are ill-placed to assume any kind of leadership role in preparing to address this crisis. What we can do is start thinking about our capacities to provide aid as it might be requested. On an individual level this may involve volunteering to work in particular communities that may be ravaged by the flu (or other medical emergencies) later this year or further in the future - if such aid is requested. Collectively, this should build on work done establishing relationships with people already living these communities. During the crisis as Garden Hill chief David Harper ended up privately purchasing the hand sanitizer the federal government was refusing to provide - this is a low-level form of aid that the movement could help provide. More ambitiously, people from St. Theresa's Point were asking why no field hospital was being set up in their community - while we do not currently have the capacity to set up a field hospital, such is certainly within the purview of our responsibilities. After all, how can a movement that can't do that hope to some day wage a.s.?

& of course, in all these circumstances, the movement's material capacities (or lack thereof) notwithstanding, pre-existing relationships with people on the ground in these communities - communities which suffer from overcrowding, poor sanitation, and populations already stricken by "pre-existing medical conditions" and deprived of adequate medical resources - will be paramount. As many revolutionaries already live in such communities, it is not so much a matter of the movement having to act in solidarity with "other people" as it is of recentering the movement around those of our comrades already living these realities.

Finally, i have to repeat - in an absolutely worst case scenario, H1N1 will still not be a horror move end of the world catastrophe, or even close. Most people will know many people who get sick (or will get sick themselves) and it will be no big deal at all, and everyone may well be laughing about how overblown their previous fears were. This is not because it won't potentially be devastating for small pockets of people, but because most of us have unrealistic ideas about what a moderately severe flu pandemic is - it is not the end of the world or the plague or anything like that. So in our rhetoric we have to acknowledge loud and clear that (barring some highly unlikely and nasty mutation) the threat is to particular vulnerable pockets of population, that it is not certain, but it is a real danger and that in order to be responsible certain precautions - i.e. medically empowering and getting resources available for vulnerable populations - should be taken.

More on this later...