The Good Samaritan: Religion and Epidemics

The parable of the Good Samaritan, the story of a man coming to the aid of a beaten and bleeding traveller ignored by other passersby, is a mainstay in the teachings of Christianity. The Good Samaritan embodies a common theme in the world’s faith traditions, the idea that we should look beyond social distinctions and self-interest to help those in need. It is a plea to lead by example, to live by the Golden Rule. At its best, organized religion achieves this kind of grace, and sets an inspirational example.

Do unto others

The relationship between religion and epidemic disease is, to put it mildly, complicated, and at times even contradictory. In the name of religion, some have denounced the sick, arguing that the spreading illness (i.e. HIV/AIDS) is a curse from God, and have impeded public health efforts. Religious cultural practices, particularly funerary rites involving contact with the remains, have inadvertently helped spread disease, such as Ebola4. But on the other hand, religious groups have also done exactly the opposite: tirelessly work to dispel the belief that epidemics are divine plagues, promote preventative practices like condom use, and tackle the challenges of illness on the ground. The work of faith-based organizations (FBOs) has been essential for the care and support of people living with some of the most intractable and frightening epidemics of the modern era, including HIV and Ebola1.

Throughout the current Ebola epidemic in West Africa, FBOs have played an important role in stemming the tide of the outbreak. Many have established medical missions, clinics staffed by foreign medical professionals, usually on a short-term basis2, in the affected region. This work demands compassion and courage, because the risks are high. The first two American cases, Dr. Kent Brantly and Nancy Writebol, contracted the disease while treating patients in Liberia at a mission run by the FBO, Samaritan’s Purse. Both survived and Brantly has publicly pointed to his faith as his inspiration, professionally and personally. After recovering, he has continued to selflessly combat the disease, setting a startling example of individual belief and bravery. Brantly had donated his plasma (infusion with the plasma of an Ebola survivor is a potential treatment for Ebola) to three patients, another medical missionary, Rick Sacra, and two infected Texan nurses, Nina Pham and Amber Vinson5.

good samaritan
The good fight.

As you would have them do unto you

As mentioned in my recent post on meningitis, by creating large, diverse groups of people, pilgrimages can present a major public health risk, and many are enormous. Each year, more than 5 million Catholics visit the Sanctuary of Our Lady of Lourdes in France. The Hajj, the Islamic holy pilgrimage to Mecca, annually draws millions of Muslims from across the globe. Perhaps the most impressive in sheer numbers is the Kumbh Mela, which occurs every three years, when Hindus travel to the holy Ganges River. During the course of celebrations in 2007, 70 million pilgrims visited Allahabad, a single city on the river’s banks, and in 2001, the movement of people was so great it could be seen from space. These incredible aggregations of people have indeed led to disease outbreaks; in fact, it was a frequent feature of the Hajj into the 20th century3.

And yet. Religious mass gatherings (a mass gathering is a large number of people attending an event at a specific site for a finite time) have overcome these very real dangers to become important examples of public health preparedness and planning in the 21st century. In particular, the Saudi Arabian government has gone to staggering lengths to address the difficulties of hosting the Hajj. Within the immediate vicinity of the holy sites, there are 141 primary health-care centers and 24 hospitals, with a total capacity of nearly 5,000 beds, including 547 beds dedicated to critical care. There are more than 15,000 doctors and nurses on staff. One hundred and thirty-six of these healthcare centers have the latest emergency management medical systems, and are staffed by over 17,000 specialized personnel. Incredibly, health services are provided at no charge3.

These herculean efforts have provided important information about institutional prevention and preparedness for mass gatherings, religious or secular (i.e. the Royal Wedding, which drew a crowd of more than 1 million people in London). The involvement of so many countries (more than 180 countries are often represented at the Hajj) has also promoted international cooperation in prevention work, and encouraged global health diplomacy3.

Epidemic disease does not always bring out the best in humanity, including religious groups. Fear can be an ugly thing. But when religious organizations are able to look past difference and disagreement and see the need of the suffering, it is an awesome demonstration of their ideals. Their work is a powerful reminder that to be good, you must do good.

References

  1. Green, EC. (2001). The impact of religious organizations in promoting HIV/AIDS prevention. The World Bank. Web. 31 December 2014.
  1. Martiniuk, ALC, M Manouchehrian, JA Negin, & AB Zwi. (2012). Brain gains: a literature review of medical missions to low and middle-income countries. BMC Health Services Research, 12:134.
  1. Memish, ZA, GM Stephens, R Steffen, QA Ahmed. (2012). Emergence of medicine for mass gatherings: lessons learned from the Hajj. Lancet Infectious Disease, 12:56-65.
  1. Osterholm, MT. “Why it’s harder to contain this Ebola epidemic”. Chicago Tribune. 4 August 2014. Chicagotribune.com. Web. 3 August 2014.
  1. Ungar, L. Ebola survivors speak of suffering, service, faith. USA Today. 8 November 2014. Web. 5 January 2015. http://www.usatoday.com/story/news/nation/2014/11/07/kent-brantly-to-speak-about-medicine-faith/18600745/

Image source: Creative Commons, http://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa

Meningitis: The Price of Piety

Aliases: meningitis

The hajj, the Islamic pilgrimage to Mecca, is the largest annual gathering of people in the world, drawing millions from more than 180 countries3. The massive size and diversity of this event, along with the challenges of pilgrimage– like extreme heat, crowded accommodations, inadequately prepared or stored food, and the advanced age of many pilgrims– makes it a an ideal environment for disease transmission1.

While no major epidemics have come in the wake of the hajj, there have been several related outbreaks of Neisseria meningitides, one of the causative agents of bacterial meningitis and meningococcal disease1,2,3. In response, the Kingdom of Saudi Arabia’s health ministry developed a three pronged approach to disease prevention: 1) compulsory vaccination for all pilgrims, 2) annual vaccination campaigns for people living at pilgrimage sites, and 3) compulsory antibiotic treatment for pilgrims from sub-Saharan Africa, a region with a high incidence of meningitis referred to as the “meningitis belt”1.

These precautions are critical; after they were relaxed in 1999, the disease bounced back. There were 1,300 and 1,109 hajj-related cases of Neisseria meningitides in 2000 and 2001, respectively1. This should serve as a warning to other nations afflicted by the disease, like the US, where there are about 4,100 cases, including 500 deaths, from meningitis each year4. The best offense is a good defense.

meningitis
Close quarters.

Cause: Meningitis is caused by bacteria, viruses, fungi, or parasites infiltrating the fluid surrounding the brain and spinal cord and causing inflammation in the meninges (the membranes that cover the brain and spinal cord). Bacterial meningitis can be transmitted person-to-person through contact with respiratory and throat secretions (aka spit), and, in the case of Listeria monocytogenes, through contaminated food. While bacterial and viral meningitis are readily spread, they are unlikely to cause disease in healthy adults; many people contract the offending pathogens without getting sick. Disease symptoms typically emerge within a week4.

Consequence: The classic triumvirate of symptoms includes the sudden onset of fever, headache, and a stiff neck. People suffering from the disease may also experience nausea, vomiting, confusion, photophobia (increased sensitivity to light), loss of appetite, and lethargy. In severe cases, it can cause seizures or coma. Bacterial meningitis is usually serious, and recovered patients may have permanent complications from the disease, including hearing loss, brain damage, and learning disabilities4.

Cure: Treatment depends on the cause of the disease. There is no treatment for viral or parasitic meningitis; people who fall sick with viral meningitis usually get better on their own within 10 days, while nearly all cases of parasitic meningitis have been fatal. Bacterial and fungal meningitis can be effectively treated with antibiotics and antifungal medications, and early treatment with antibiotics reduces the fatality rate of bacterial meningitis to less than 15%. Prevention is critical; the most effective way to ward off the disease is to complete the recommended vaccine schedule, which protects from common agents of bacterial and viral meningitis4.

References

  1. Ahmed, QA, YM Arabi, & ZA Memish. (2006). Health risks at the Hajj. Lancet, 367:1008-1015.
  1. Khalil, MKM, & R Borrow. (2009). Serogroup B meningococcal disease during Hajj: preparing for the worst scenario. Travel Medicine and Infectious Disease, 7:231-234.
  1. Memish, ZA, GM Stephens, R Steffen, & QA Ahmed. (2012). Emergence of medicine for mass gatherings: lessons from the Hajj. Lancet Infectious Disease, 12:56-65.
  1. “Meningitis”. Centers for Disease Control and Prevention. 26 November 2014. Web. 23 December 2014.

Image source: Creative Commons, http://commons.wikimedia.org/wiki/File:The_Hajj_kicks_into_full_gear_-_Flickr_-_Al_Jazeera_English_(8).jpg